| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
28,476 |
24,306 |
$737K |
| D0120 |
Periodic oral evaluation - established patient |
23,047 |
19,137 |
$518K |
| D1351 |
Sealant - per tooth |
13,238 |
2,053 |
$347K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,668 |
873 |
$331K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,666 |
7,783 |
$323K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,056 |
17,616 |
$275K |
| D0272 |
Bitewings - two radiographic images |
16,691 |
13,324 |
$273K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,481 |
1,739 |
$259K |
| D1206 |
Topical application of fluoride varnish |
9,849 |
9,246 |
$237K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,290 |
1,405 |
$176K |
| D0140 |
Limited oral evaluation - problem focused |
4,223 |
3,685 |
$161K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,557 |
684 |
$137K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,739 |
1,085 |
$130K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,308 |
3,709 |
$108K |
| D0330 |
Panoramic radiographic image |
1,256 |
1,144 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
3,375 |
3,079 |
$44K |
| D1110 |
Prophylaxis - adult |
984 |
690 |
$35K |
| D1510 |
|
30 |
27 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
177 |
126 |
$2K |