| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
32,201 |
31,882 |
$895K |
| D0120 |
Periodic oral evaluation - established patient |
39,398 |
39,017 |
$657K |
| D1206 |
Topical application of fluoride varnish |
32,170 |
31,835 |
$549K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,301 |
1,228 |
$488K |
| D1110 |
Prophylaxis - adult |
12,406 |
12,296 |
$481K |
| D0272 |
Bitewings - two radiographic images |
18,706 |
18,518 |
$321K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,470 |
2,593 |
$281K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,177 |
2,405 |
$280K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,511 |
7,297 |
$226K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,169 |
2,301 |
$205K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,396 |
10,319 |
$191K |
| D9994 |
|
18,215 |
17,616 |
$149K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,843 |
4,787 |
$129K |
| D1351 |
Sealant - per tooth |
4,856 |
1,433 |
$111K |
| D0210 |
Intraoral - complete series of radiographic images |
2,054 |
2,001 |
$82K |
| D0220 |
Intraoral - periapical first radiographic image |
9,082 |
8,957 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,223 |
4,362 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
2,284 |
2,247 |
$50K |
| D8670 |
Periodic orthodontic treatment visit |
51 |
51 |
$33K |
| D0330 |
Panoramic radiographic image |
577 |
577 |
$29K |
| D0274 |
Bitewings - four radiographic images |
934 |
931 |
$19K |
| D3120 |
|
986 |
426 |
$14K |
| D0240 |
|
1,604 |
853 |
$13K |
| D9310 |
|
108 |
108 |
$8K |
| D9920 |
|
113 |
109 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
69 |
51 |
$6K |
| D1510 |
|
51 |
28 |
$4K |
| D9630 |
|
309 |
308 |
$2K |
| D9992 |
|
221 |
221 |
$1K |
| D9248 |
|
13 |
13 |
$0.00 |
| D9990 |
|
65 |
65 |
$0.00 |