| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,328 |
10,503 |
$363K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,708 |
1,955 |
$308K |
| D1206 |
Topical application of fluoride varnish |
13,881 |
12,805 |
$279K |
| D1351 |
Sealant - per tooth |
10,041 |
1,779 |
$255K |
| D0120 |
Periodic oral evaluation - established patient |
11,222 |
10,352 |
$235K |
| D0272 |
Bitewings - two radiographic images |
8,354 |
7,746 |
$185K |
| D1110 |
Prophylaxis - adult |
3,540 |
3,228 |
$148K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,510 |
1,362 |
$130K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,100 |
2,857 |
$107K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,179 |
512 |
$101K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,339 |
2,746 |
$94K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
642 |
264 |
$88K |
| D0330 |
Panoramic radiographic image |
870 |
807 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,306 |
1,212 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,137 |
1,045 |
$33K |
| D0160 |
|
487 |
455 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,896 |
1,735 |
$22K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
137 |
75 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
377 |
155 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
25 |
$2K |
| D2331 |
|
22 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
73 |
68 |
$2K |
| D1352 |
|
22 |
12 |
$850.45 |
| D1999 |
|
659 |
604 |
$560.00 |
| D9920 |
|
13 |
12 |
$372.14 |
| D3120 |
|
714 |
428 |
$0.00 |
| D0603 |
|
11,318 |
10,417 |
$0.00 |