| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
19,714 |
19,269 |
$811K |
| D1206 |
Topical application of fluoride varnish |
19,519 |
19,068 |
$509K |
| D0120 |
Periodic oral evaluation - established patient |
17,611 |
17,150 |
$495K |
| D1351 |
Sealant - per tooth |
5,121 |
3,482 |
$486K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,445 |
2,872 |
$283K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,348 |
3,115 |
$151K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,109 |
1,830 |
$103K |
| D0274 |
Bitewings - four radiographic images |
4,211 |
4,099 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
11,984 |
11,591 |
$72K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
716 |
652 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,053 |
909 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,583 |
2,541 |
$59K |
| D0272 |
Bitewings - two radiographic images |
5,683 |
5,543 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,567 |
10,218 |
$49K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
597 |
545 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,145 |
1,123 |
$20K |
| D9310 |
|
96 |
96 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
13 |
$1K |
| D1999 |
|
1,173 |
924 |
$0.00 |