| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,295 |
10,921 |
$295K |
| D0120 |
Periodic oral evaluation - established patient |
12,587 |
12,193 |
$229K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,254 |
11,853 |
$184K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,772 |
1,136 |
$131K |
| D1110 |
Prophylaxis - adult |
2,460 |
2,386 |
$86K |
| D0272 |
Bitewings - two radiographic images |
4,042 |
3,914 |
$69K |
| D0330 |
Panoramic radiographic image |
1,104 |
1,074 |
$51K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
431 |
150 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
623 |
447 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,128 |
1,075 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,348 |
2,239 |
$25K |
| D1351 |
Sealant - per tooth |
1,217 |
343 |
$24K |
| D0274 |
Bitewings - four radiographic images |
941 |
913 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
870 |
777 |
$21K |
| D1206 |
Topical application of fluoride varnish |
823 |
788 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
653 |
611 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
198 |
111 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
337 |
242 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
24 |
12 |
$2K |
| D0273 |
|
41 |
41 |
$828.15 |
| D0240 |
|
36 |
36 |
$442.08 |
| D9420 |
|
16 |
12 |
$327.44 |
| D1999 |
|
259 |
254 |
$0.00 |