| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
27,929 |
24,717 |
$546K |
| D0120 |
Periodic oral evaluation - established patient |
22,056 |
19,540 |
$366K |
| D1206 |
Topical application of fluoride varnish |
24,382 |
22,834 |
$360K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,799 |
1,038 |
$273K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,759 |
5,794 |
$177K |
| D1351 |
Sealant - per tooth |
6,995 |
1,882 |
$148K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,934 |
1,647 |
$146K |
| D1354 |
|
9,716 |
4,000 |
$144K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,675 |
1,389 |
$128K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,707 |
3,927 |
$123K |
| D0330 |
Panoramic radiographic image |
2,520 |
2,448 |
$114K |
| D0272 |
Bitewings - two radiographic images |
11,437 |
10,302 |
$111K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,640 |
876 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,844 |
2,099 |
$57K |
| D0240 |
|
3,694 |
2,056 |
$44K |
| D1320 |
|
2,548 |
2,098 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,690 |
1,518 |
$37K |
| D2140 |
|
467 |
278 |
$18K |
| D1110 |
Prophylaxis - adult |
515 |
436 |
$16K |
| D1510 |
|
125 |
101 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
238 |
140 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
169 |
88 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,656 |
1,599 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
387 |
376 |
$2K |
| D0274 |
Bitewings - four radiographic images |
54 |
54 |
$1K |
| D3120 |
|
120 |
47 |
$0.00 |