| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
22,122 |
21,574 |
$689K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,551 |
12,208 |
$432K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,648 |
1,917 |
$413K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,659 |
3,301 |
$332K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,136 |
4,053 |
$330K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,923 |
10,069 |
$293K |
| D1206 |
Topical application of fluoride varnish |
14,440 |
14,034 |
$261K |
| D0120 |
Periodic oral evaluation - established patient |
10,708 |
10,481 |
$237K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,148 |
15,478 |
$234K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,594 |
2,178 |
$234K |
| D0220 |
Intraoral - periapical first radiographic image |
18,683 |
18,058 |
$208K |
| D0272 |
Bitewings - two radiographic images |
10,226 |
9,951 |
$205K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,863 |
10,631 |
$194K |
| D0274 |
Bitewings - four radiographic images |
5,684 |
5,550 |
$165K |
| D1351 |
Sealant - per tooth |
6,474 |
2,043 |
$122K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,265 |
637 |
$93K |
| D1110 |
Prophylaxis - adult |
1,978 |
1,919 |
$72K |
| D0140 |
Limited oral evaluation - problem focused |
1,904 |
1,829 |
$55K |
| D0330 |
Panoramic radiographic image |
667 |
646 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
110 |
85 |
$8K |
| D2332 |
|
61 |
50 |
$7K |
| D2932 |
|
49 |
26 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
26 |
$3K |
| D2330 |
|
36 |
26 |
$2K |
| D2140 |
|
34 |
27 |
$2K |
| D9420 |
|
28 |
25 |
$2K |
| D1999 |
|
62 |
57 |
$0.00 |