| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
15,516 |
15,361 |
$489K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,739 |
8,683 |
$304K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,228 |
16,072 |
$293K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,977 |
1,877 |
$216K |
| D0120 |
Periodic oral evaluation - established patient |
7,392 |
7,336 |
$168K |
| D0272 |
Bitewings - two radiographic images |
6,492 |
6,445 |
$132K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,913 |
4,619 |
$132K |
| D0274 |
Bitewings - four radiographic images |
3,996 |
3,972 |
$118K |
| D0220 |
Intraoral - periapical first radiographic image |
8,950 |
8,838 |
$101K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,776 |
1,336 |
$97K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,715 |
7,520 |
$71K |
| D1351 |
Sealant - per tooth |
2,640 |
874 |
$63K |
| D0330 |
Panoramic radiographic image |
1,188 |
1,185 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
567 |
402 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,226 |
1,202 |
$36K |
| D0240 |
|
2,826 |
1,791 |
$36K |
| D1110 |
Prophylaxis - adult |
445 |
443 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
120 |
80 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
135 |
114 |
$12K |
| D9248 |
|
134 |
132 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
19 |
12 |
$2K |
| D0270 |
|
70 |
69 |
$697.16 |
| D1999 |
|
199 |
136 |
$0.00 |