| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,860 |
7,526 |
$346K |
| D1206 |
Topical application of fluoride varnish |
7,123 |
6,868 |
$257K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,063 |
3,883 |
$125K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,591 |
1,113 |
$123K |
| D0272 |
Bitewings - two radiographic images |
7,270 |
6,946 |
$119K |
| D0120 |
Periodic oral evaluation - established patient |
4,098 |
3,948 |
$96K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,276 |
488 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
9,000 |
8,538 |
$69K |
| D9248 |
|
843 |
780 |
$66K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,771 |
962 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,928 |
8,059 |
$56K |
| D0330 |
Panoramic radiographic image |
1,359 |
1,307 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
974 |
515 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,740 |
2,566 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
991 |
941 |
$31K |
| D1351 |
Sealant - per tooth |
1,474 |
401 |
$21K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
439 |
211 |
$19K |
| D9310 |
|
429 |
400 |
$15K |
| D0999 |
Unspecified diagnostic procedure, by report |
328 |
328 |
$10K |
| D9999 |
Unspecified adjunctive procedure, by report |
417 |
417 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
457 |
427 |
$4K |
| D1999 |
|
187 |
187 |
$1K |