| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,301 |
13,993 |
$532K |
| D1351 |
Sealant - per tooth |
13,205 |
3,384 |
$287K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,514 |
13,212 |
$250K |
| D0120 |
Periodic oral evaluation - established patient |
9,702 |
9,492 |
$236K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,494 |
2,238 |
$192K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,195 |
5,088 |
$174K |
| D9248 |
|
1,489 |
1,385 |
$167K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,836 |
1,577 |
$144K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,155 |
724 |
$114K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,150 |
1,442 |
$105K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,274 |
760 |
$77K |
| D0240 |
|
3,705 |
3,526 |
$67K |
| D0272 |
Bitewings - two radiographic images |
5,728 |
5,624 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,746 |
3,532 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,416 |
1,372 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
432 |
432 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
3,682 |
3,626 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,014 |
2,948 |
$16K |
| D0603 |
|
1,958 |
1,897 |
$14K |
| D0274 |
Bitewings - four radiographic images |
1,271 |
1,249 |
$14K |
| D0330 |
Panoramic radiographic image |
436 |
432 |
$14K |
| D1206 |
Topical application of fluoride varnish |
846 |
839 |
$10K |
| D0601 |
|
1,147 |
1,072 |
$7K |
| D1110 |
Prophylaxis - adult |
112 |
104 |
$4K |
| D0602 |
|
458 |
441 |
$3K |
| D9420 |
|
13 |
12 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
70 |
70 |
$12.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
16 |
16 |
$0.00 |