| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
29,946 |
29,609 |
$237K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,711 |
7,398 |
$201K |
| D0120 |
Periodic oral evaluation - established patient |
31,284 |
30,973 |
$173K |
| D1208 |
Topical application of fluoride, excluding varnish |
35,223 |
34,804 |
$133K |
| D0220 |
Intraoral - periapical first radiographic image |
39,272 |
38,728 |
$108K |
| D0272 |
Bitewings - two radiographic images |
22,736 |
22,486 |
$93K |
| D0230 |
Intraoral - periapical each additional radiographic image |
39,719 |
37,358 |
$89K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,240 |
1,281 |
$88K |
| D1110 |
Prophylaxis - adult |
6,557 |
6,481 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,862 |
2,554 |
$59K |
| D0274 |
Bitewings - four radiographic images |
7,550 |
7,465 |
$45K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,554 |
562 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,936 |
900 |
$31K |
| D0330 |
Panoramic radiographic image |
2,525 |
2,462 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,726 |
5,542 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,036 |
3,983 |
$22K |
| D1351 |
Sealant - per tooth |
3,171 |
1,164 |
$15K |
| D9248 |
|
715 |
693 |
$8K |
| D1206 |
Topical application of fluoride varnish |
1,538 |
1,523 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
233 |
185 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
814 |
804 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
506 |
500 |
$3K |
| D2933 |
|
40 |
12 |
$1K |
| D3230 |
|
65 |
25 |
$1K |
| D9430 |
|
37 |
36 |
$298.77 |
| D3120 |
|
17 |
13 |
$114.83 |
| D0603 |
|
3,799 |
3,633 |
$0.00 |
| D0602 |
|
5,036 |
4,826 |
$0.00 |
| D0601 |
|
2,744 |
2,637 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
56 |
56 |
$0.00 |