| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
17,278 |
17,090 |
$467K |
| D1206 |
Topical application of fluoride varnish |
19,059 |
18,855 |
$321K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,318 |
1,273 |
$264K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,676 |
2,339 |
$263K |
| D0120 |
Periodic oral evaluation - established patient |
14,774 |
14,601 |
$236K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,627 |
1,675 |
$170K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,794 |
5,526 |
$162K |
| D0272 |
Bitewings - two radiographic images |
8,005 |
7,905 |
$131K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,418 |
1,379 |
$129K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,773 |
4,737 |
$128K |
| D0220 |
Intraoral - periapical first radiographic image |
11,407 |
11,230 |
$103K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,793 |
10,116 |
$98K |
| D1110 |
Prophylaxis - adult |
1,929 |
1,910 |
$73K |
| D1351 |
Sealant - per tooth |
3,966 |
1,151 |
$69K |
| D0210 |
Intraoral - complete series of radiographic images |
3,239 |
2,402 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,359 |
1,344 |
$30K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
359 |
252 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
510 |
500 |
$10K |
| D0330 |
Panoramic radiographic image |
347 |
347 |
$9K |
| D2929 |
|
32 |
12 |
$5K |
| D3230 |
|
33 |
12 |
$5K |
| D2330 |
|
39 |
25 |
$3K |