| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
18,395 |
18,102 |
$237K |
| D0120 |
Periodic oral evaluation - established patient |
18,525 |
18,247 |
$159K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,998 |
2,128 |
$106K |
| D1206 |
Topical application of fluoride varnish |
16,329 |
16,002 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
22,287 |
21,806 |
$97K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,720 |
20,278 |
$82K |
| D0272 |
Bitewings - two radiographic images |
11,612 |
11,416 |
$79K |
| D1351 |
Sealant - per tooth |
8,741 |
2,560 |
$74K |
| D0274 |
Bitewings - four radiographic images |
7,008 |
6,865 |
$72K |
| D1110 |
Prophylaxis - adult |
3,480 |
3,410 |
$60K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,494 |
676 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,755 |
1,018 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,139 |
6,058 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,607 |
1,088 |
$38K |
| D0330 |
Panoramic radiographic image |
2,761 |
2,712 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,690 |
3,555 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,335 |
1,302 |
$21K |
| D9248 |
|
867 |
840 |
$20K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,231 |
1,212 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
780 |
759 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
215 |
119 |
$8K |
| D1354 |
|
335 |
127 |
$2K |
| D3120 |
|
201 |
132 |
$1K |
| D2330 |
|
24 |
12 |
$735.85 |
| D1999 |
|
304 |
303 |
$607.50 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$474.99 |
| D0602 |
|
2,653 |
2,440 |
$0.00 |
| D0603 |
|
7,568 |
7,388 |
$0.00 |