| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
15,010 |
14,861 |
$422K |
| D1206 |
Topical application of fluoride varnish |
22,503 |
22,262 |
$387K |
| D0120 |
Periodic oral evaluation - established patient |
20,961 |
20,725 |
$346K |
| D9920 |
|
5,182 |
4,872 |
$286K |
| D1110 |
Prophylaxis - adult |
7,468 |
7,380 |
$279K |
| D9630 |
|
14,077 |
13,849 |
$225K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,457 |
1,405 |
$204K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,262 |
1,448 |
$148K |
| D0274 |
Bitewings - four radiographic images |
4,026 |
3,975 |
$89K |
| D0272 |
Bitewings - two radiographic images |
4,897 |
4,850 |
$84K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,769 |
2,591 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
865 |
864 |
$23K |
| D1351 |
Sealant - per tooth |
997 |
358 |
$21K |
| D0330 |
Panoramic radiographic image |
330 |
329 |
$13K |
| D3120 |
|
759 |
570 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
323 |
319 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
55 |
40 |
$5K |
| D1354 |
|
80 |
24 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
27 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
15 |
12 |
$1K |
| D0240 |
|
85 |
43 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
55 |
55 |
$592.54 |
| D1999 |
|
192 |
192 |
$0.00 |