| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
25,845 |
24,328 |
$1.07M |
| D1206 |
Topical application of fluoride varnish |
24,948 |
23,474 |
$809K |
| D0120 |
Periodic oral evaluation - established patient |
20,541 |
19,462 |
$477K |
| D0272 |
Bitewings - two radiographic images |
21,769 |
20,445 |
$359K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,238 |
629 |
$154K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,632 |
4,324 |
$141K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,487 |
1,187 |
$117K |
| D1351 |
Sealant - per tooth |
4,729 |
1,064 |
$99K |
| D9248 |
|
1,140 |
1,053 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,205 |
1,111 |
$77K |
| D0330 |
Panoramic radiographic image |
1,435 |
1,360 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,080 |
3,753 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,904 |
3,648 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
530 |
281 |
$31K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,017 |
1,017 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,370 |
3,612 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
950 |
867 |
$28K |
| D0999 |
Unspecified diagnostic procedure, by report |
778 |
778 |
$23K |
| D1354 |
|
962 |
304 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
322 |
157 |
$11K |
| D3120 |
|
144 |
80 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
46 |
28 |
$2K |
| D1999 |
|
638 |
593 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$2K |
| D9420 |
|
46 |
39 |
$1K |
| D0601 |
|
1,899 |
1,871 |
$1K |
| D0602 |
|
1,362 |
1,335 |
$916.00 |
| D0603 |
|
903 |
873 |
$644.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
25 |
24 |
$236.50 |