| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,868 |
8,278 |
$348K |
| D1206 |
Topical application of fluoride varnish |
7,760 |
7,357 |
$253K |
| D0120 |
Periodic oral evaluation - established patient |
6,782 |
6,415 |
$144K |
| D9248 |
|
1,557 |
1,367 |
$128K |
| D0272 |
Bitewings - two radiographic images |
6,819 |
6,415 |
$114K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,601 |
370 |
$91K |
| D0240 |
|
6,929 |
6,471 |
$91K |
| D1351 |
Sealant - per tooth |
4,141 |
752 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
5,972 |
5,558 |
$57K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
931 |
414 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,582 |
4,308 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
905 |
865 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
646 |
312 |
$22K |
| D9310 |
|
489 |
459 |
$17K |
| D0330 |
Panoramic radiographic image |
395 |
366 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
312 |
113 |
$13K |
| D1353 |
|
765 |
177 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,953 |
1,744 |
$9K |
| D0999 |
Unspecified diagnostic procedure, by report |
281 |
281 |
$8K |
| D9999 |
Unspecified adjunctive procedure, by report |
331 |
331 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
722 |
625 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
172 |
160 |
$5K |
| D2933 |
|
56 |
13 |
$5K |
| D9420 |
|
61 |
54 |
$2K |
| D0602 |
|
389 |
354 |
$2K |
| D0274 |
Bitewings - four radiographic images |
81 |
71 |
$2K |
| D1999 |
|
64 |
64 |
$960.00 |