| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,364 |
12,440 |
$544K |
| D0120 |
Periodic oral evaluation - established patient |
12,829 |
11,922 |
$358K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,262 |
12,343 |
$343K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,145 |
2,223 |
$217K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,064 |
3,674 |
$169K |
| D1351 |
Sealant - per tooth |
2,478 |
1,242 |
$149K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
982 |
762 |
$122K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,945 |
1,487 |
$114K |
| D0272 |
Bitewings - two radiographic images |
6,943 |
6,471 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,253 |
969 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,761 |
1,702 |
$41K |
| D9110 |
|
511 |
494 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,817 |
2,640 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
209 |
180 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,179 |
849 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
425 |
394 |
$7K |
| D2332 |
|
58 |
39 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
22 |
19 |
$2K |
| D0330 |
Panoramic radiographic image |
60 |
55 |
$2K |
| D0274 |
Bitewings - four radiographic images |
77 |
77 |
$2K |
| D9996 |
|
17 |
15 |
$64.68 |
| D1999 |
|
2,862 |
2,596 |
$0.00 |