| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
30,227 |
29,566 |
$710K |
| D0120 |
Periodic oral evaluation - established patient |
32,673 |
31,990 |
$683K |
| D1206 |
Topical application of fluoride varnish |
33,514 |
32,782 |
$681K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,220 |
1,500 |
$641K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,247 |
3,846 |
$441K |
| D1351 |
Sealant - per tooth |
12,913 |
3,890 |
$303K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,943 |
7,605 |
$258K |
| D0272 |
Bitewings - two radiographic images |
15,658 |
15,320 |
$189K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,730 |
1,241 |
$187K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,927 |
1,937 |
$179K |
| D1110 |
Prophylaxis - adult |
3,772 |
3,685 |
$163K |
| D0330 |
Panoramic radiographic image |
1,206 |
1,183 |
$66K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
629 |
283 |
$45K |
| D0240 |
|
4,109 |
1,704 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,594 |
1,529 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,463 |
1,412 |
$39K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
646 |
271 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
1,044 |
1,021 |
$7K |
| D1354 |
|
391 |
210 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
25 |
$4K |
| D0274 |
Bitewings - four radiographic images |
57 |
56 |
$2K |
| D2140 |
|
29 |
26 |
$1K |
| D0350 |
|
39 |
39 |
$893.76 |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
12 |
$117.96 |
| D9420 |
|
629 |
607 |
$0.00 |