| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
23,425 |
23,247 |
$745K |
| D0120 |
Periodic oral evaluation - established patient |
22,762 |
22,597 |
$518K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,928 |
1,885 |
$449K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,384 |
3,443 |
$396K |
| D1206 |
Topical application of fluoride varnish |
16,066 |
15,950 |
$293K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,374 |
2,725 |
$292K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,915 |
3,197 |
$280K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,093 |
8,862 |
$240K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,348 |
9,267 |
$168K |
| D0272 |
Bitewings - two radiographic images |
7,773 |
7,707 |
$158K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,796 |
885 |
$135K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,836 |
3,798 |
$135K |
| D0140 |
Limited oral evaluation - problem focused |
4,494 |
4,417 |
$131K |
| D1351 |
Sealant - per tooth |
5,131 |
1,397 |
$123K |
| D0220 |
Intraoral - periapical first radiographic image |
7,177 |
7,096 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,857 |
5,149 |
$62K |
| D0274 |
Bitewings - four radiographic images |
1,432 |
1,422 |
$43K |
| D9248 |
|
1,183 |
1,160 |
$42K |
| D2331 |
|
115 |
80 |
$10K |
| D2330 |
|
125 |
79 |
$9K |
| D1510 |
|
16 |
13 |
$2K |
| D1110 |
Prophylaxis - adult |
43 |
43 |
$2K |
| D0240 |
|
118 |
115 |
$1K |
| D9420 |
|
14 |
14 |
$1K |
| D9985 |
|
935 |
854 |
$0.00 |