| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,869 |
3,396 |
$265K |
| D0120 |
Periodic oral evaluation - established patient |
7,364 |
6,405 |
$235K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,721 |
946 |
$101K |
| D1120 |
Prophylaxis - child |
5,506 |
4,911 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,926 |
1,849 |
$78K |
| D0330 |
Panoramic radiographic image |
1,476 |
1,306 |
$33K |
| D1351 |
Sealant - per tooth |
6,649 |
1,165 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,210 |
961 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,098 |
8,169 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
48 |
27 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
91 |
52 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
8,386 |
7,432 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
213 |
138 |
$5K |
| D0274 |
Bitewings - four radiographic images |
3,869 |
3,415 |
$5K |
| D1330 |
|
9,289 |
8,284 |
$4K |
| D0272 |
Bitewings - two radiographic images |
4,235 |
3,779 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,514 |
7,271 |
$3K |
| D3120 |
|
1,260 |
682 |
$3K |
| D0601 |
|
3,723 |
3,675 |
$2K |
| D1999 |
|
50 |
49 |
$663.09 |
| D0602 |
|
99 |
99 |
$340.72 |
| D1206 |
Topical application of fluoride varnish |
191 |
178 |
$224.51 |
| D9986 |
|
108 |
100 |
$0.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
50 |
28 |
$0.00 |