| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,088 |
13,719 |
$385K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,423 |
2,531 |
$319K |
| D0120 |
Periodic oral evaluation - established patient |
14,473 |
14,012 |
$263K |
| D1206 |
Topical application of fluoride varnish |
18,100 |
17,566 |
$242K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,344 |
1,034 |
$190K |
| D0272 |
Bitewings - two radiographic images |
11,278 |
10,973 |
$165K |
| D1351 |
Sealant - per tooth |
9,467 |
2,388 |
$163K |
| D0220 |
Intraoral - periapical first radiographic image |
16,964 |
16,358 |
$152K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,001 |
1,723 |
$147K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,155 |
15,994 |
$128K |
| D1110 |
Prophylaxis - adult |
4,170 |
4,006 |
$127K |
| D0274 |
Bitewings - four radiographic images |
4,689 |
4,488 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,272 |
3,185 |
$89K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,225 |
539 |
$81K |
| D0330 |
Panoramic radiographic image |
2,504 |
2,421 |
$72K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,294 |
3,078 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,099 |
647 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,165 |
1,124 |
$28K |
| D2332 |
|
102 |
61 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
240 |
240 |
$5K |
| D1999 |
|
305 |
297 |
$4K |
| D9248 |
|
89 |
84 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
48 |
38 |
$3K |
| D2330 |
|
39 |
24 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
35 |
35 |
$571.17 |
| D1330 |
|
12,712 |
12,130 |
$261.30 |
| D9920 |
|
179 |
116 |
$41.64 |