| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,759 |
16,747 |
$534K |
| D1351 |
Sealant - per tooth |
10,319 |
3,475 |
$415K |
| D0120 |
Periodic oral evaluation - established patient |
13,278 |
13,270 |
$293K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,641 |
3,163 |
$284K |
| D1206 |
Topical application of fluoride varnish |
8,953 |
8,940 |
$220K |
| D0220 |
Intraoral - periapical first radiographic image |
18,107 |
18,049 |
$200K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,306 |
1,633 |
$184K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,950 |
2,891 |
$147K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,526 |
6,517 |
$134K |
| D1110 |
Prophylaxis - adult |
3,112 |
3,109 |
$128K |
| D0274 |
Bitewings - four radiographic images |
6,026 |
6,023 |
$126K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,005 |
10,994 |
$124K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,350 |
1,790 |
$124K |
| D0272 |
Bitewings - two radiographic images |
8,894 |
8,888 |
$112K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,343 |
16,321 |
$96K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,355 |
1,029 |
$78K |
| D9990 |
|
2,929 |
2,878 |
$61K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
518 |
408 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
2,297 |
2,263 |
$26K |
| D1354 |
|
1,362 |
310 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
675 |
660 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
413 |
411 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
191 |
191 |
$5K |
| D0273 |
|
122 |
122 |
$2K |
| D9110 |
|
13 |
12 |
$148.60 |
| D1310 |
|
434 |
434 |
$0.00 |
| D1330 |
|
441 |
441 |
$0.00 |
| D0240 |
|
42 |
42 |
$0.00 |