| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,774 |
10,368 |
$383K |
| D1351 |
Sealant - per tooth |
15,911 |
2,885 |
$351K |
| D0120 |
Periodic oral evaluation - established patient |
11,334 |
10,872 |
$327K |
| D1206 |
Topical application of fluoride varnish |
15,456 |
14,817 |
$254K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,569 |
1,664 |
$252K |
| D1110 |
Prophylaxis - adult |
4,504 |
4,304 |
$223K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,458 |
1,744 |
$195K |
| D0330 |
Panoramic radiographic image |
1,728 |
1,644 |
$97K |
| D0272 |
Bitewings - two radiographic images |
4,464 |
4,281 |
$90K |
| D0274 |
Bitewings - four radiographic images |
2,781 |
2,669 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,197 |
1,164 |
$64K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,856 |
2,558 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
578 |
313 |
$53K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
377 |
174 |
$44K |
| D1354 |
|
1,618 |
483 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
194 |
144 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
1,041 |
985 |
$25K |
| D0190 |
|
1,180 |
1,138 |
$24K |
| D1330 |
|
1,746 |
1,626 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,620 |
1,529 |
$22K |
| D3120 |
|
932 |
708 |
$18K |
| D1310 |
|
719 |
713 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
966 |
458 |
$11K |
| D2332 |
|
58 |
39 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
16 |
13 |
$2K |
| D1320 |
|
84 |
83 |
$2K |
| D2331 |
|
15 |
13 |
$1K |
| D0240 |
|
71 |
68 |
$1K |
| D9248 |
|
12 |
12 |
$1K |
| D9920 |
|
26 |
26 |
$897.00 |
| D8660 |
|
36 |
33 |
$675.00 |
| D9996 |
|
1,221 |
1,168 |
$0.00 |
| D0191 |
|
59 |
53 |
$0.00 |
| D1353 |
|
587 |
174 |
$0.00 |