| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,677 |
13,155 |
$560K |
| D1351 |
Sealant - per tooth |
8,729 |
4,409 |
$559K |
| D0120 |
Periodic oral evaluation - established patient |
12,553 |
12,030 |
$351K |
| D1206 |
Topical application of fluoride varnish |
9,032 |
8,831 |
$238K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,890 |
1,414 |
$124K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,357 |
1,166 |
$118K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,563 |
4,243 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,434 |
1,251 |
$94K |
| D0274 |
Bitewings - four radiographic images |
4,418 |
4,241 |
$78K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
962 |
901 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,410 |
2,319 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
8,107 |
7,704 |
$49K |
| D2160 |
|
620 |
512 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,429 |
5,861 |
$35K |
| D0272 |
Bitewings - two radiographic images |
3,500 |
3,286 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
657 |
535 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
1,257 |
1,225 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
364 |
334 |
$15K |
| D2140 |
|
338 |
283 |
$12K |
| D1110 |
Prophylaxis - adult |
302 |
287 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
44 |
43 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
44 |
43 |
$3K |
| D0270 |
|
14 |
14 |
$78.40 |
| D1999 |
|
803 |
620 |
$0.00 |