| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,945 |
16,343 |
$522K |
| D0120 |
Periodic oral evaluation - established patient |
20,313 |
19,529 |
$450K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,029 |
18,281 |
$361K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,978 |
792 |
$211K |
| D1110 |
Prophylaxis - adult |
4,931 |
4,725 |
$192K |
| D0272 |
Bitewings - two radiographic images |
11,661 |
11,210 |
$188K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,396 |
5,834 |
$181K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,834 |
1,114 |
$124K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,915 |
985 |
$107K |
| D0330 |
Panoramic radiographic image |
1,989 |
1,906 |
$87K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,151 |
759 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,807 |
1,777 |
$50K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
613 |
255 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,510 |
3,337 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,880 |
1,835 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
449 |
317 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,163 |
1,066 |
$10K |
| D9248 |
|
112 |
108 |
$10K |
| D1351 |
Sealant - per tooth |
83 |
26 |
$2K |
| D2140 |
|
39 |
24 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
12 |
$1K |
| D9110 |
|
12 |
12 |
$522.68 |
| D1330 |
|
55 |
55 |
$0.00 |