| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
15,445 |
15,078 |
$321K |
| D0120 |
Periodic oral evaluation - established patient |
18,360 |
17,949 |
$253K |
| D1206 |
Topical application of fluoride varnish |
20,151 |
19,712 |
$208K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,967 |
1,740 |
$179K |
| D0272 |
Bitewings - two radiographic images |
11,290 |
11,015 |
$128K |
| D0274 |
Bitewings - four radiographic images |
8,072 |
7,903 |
$125K |
| D1110 |
Prophylaxis - adult |
5,118 |
5,011 |
$119K |
| D0220 |
Intraoral - periapical first radiographic image |
16,253 |
15,851 |
$110K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,651 |
735 |
$100K |
| D1351 |
Sealant - per tooth |
7,136 |
1,733 |
$100K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,609 |
14,985 |
$90K |
| D0240 |
|
5,923 |
5,230 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,931 |
1,153 |
$72K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,732 |
1,013 |
$71K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,202 |
553 |
$60K |
| D0330 |
Panoramic radiographic image |
2,627 |
2,562 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,579 |
2,533 |
$52K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,403 |
2,292 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,452 |
1,403 |
$28K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,303 |
1,278 |
$22K |
| D9248 |
|
518 |
494 |
$21K |
| D0602 |
|
572 |
531 |
$0.00 |
| D0601 |
|
12 |
12 |
$0.00 |