| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,892 |
12,338 |
$517K |
| D1351 |
Sealant - per tooth |
4,654 |
2,550 |
$333K |
| D1206 |
Topical application of fluoride varnish |
12,626 |
12,072 |
$322K |
| D0120 |
Periodic oral evaluation - established patient |
10,344 |
9,894 |
$285K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,207 |
2,506 |
$224K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,245 |
3,059 |
$67K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,036 |
1,760 |
$66K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,573 |
1,310 |
$62K |
| D0274 |
Bitewings - four radiographic images |
2,528 |
2,391 |
$41K |
| D0272 |
Bitewings - two radiographic images |
3,709 |
3,512 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
2,067 |
1,940 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
582 |
487 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
5,077 |
4,738 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,423 |
3,987 |
$23K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
101 |
84 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
112 |
88 |
$6K |
| D0330 |
Panoramic radiographic image |
426 |
395 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
417 |
396 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
84 |
57 |
$5K |
| D1110 |
Prophylaxis - adult |
152 |
149 |
$4K |
| D9110 |
|
44 |
39 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
24 |
$967.45 |
| D0270 |
|
131 |
129 |
$687.00 |
| D9310 |
|
46 |
44 |
$684.00 |
| D0601 |
|
294 |
289 |
$0.00 |
| D0602 |
|
213 |
207 |
$0.00 |
| D0603 |
|
67 |
65 |
$0.00 |
| D1999 |
|
1,310 |
1,067 |
$0.00 |