| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
26,690 |
26,281 |
$367K |
| D0120 |
Periodic oral evaluation - established patient |
30,329 |
29,899 |
$271K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,145 |
4,355 |
$233K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,447 |
4,541 |
$189K |
| D1206 |
Topical application of fluoride varnish |
16,259 |
16,013 |
$125K |
| D1110 |
Prophylaxis - adult |
7,393 |
7,292 |
$117K |
| D0220 |
Intraoral - periapical first radiographic image |
23,499 |
23,119 |
$109K |
| D1351 |
Sealant - per tooth |
11,615 |
4,344 |
$105K |
| D0330 |
Panoramic radiographic image |
5,514 |
5,423 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,120 |
16,862 |
$96K |
| D0272 |
Bitewings - two radiographic images |
14,129 |
13,887 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,292 |
15,668 |
$64K |
| D1999 |
|
16,057 |
14,034 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,906 |
3,821 |
$60K |
| D0274 |
Bitewings - four radiographic images |
5,294 |
5,214 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,725 |
895 |
$47K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
828 |
269 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,164 |
3,929 |
$37K |
| D1354 |
|
608 |
233 |
$4K |
| D9248 |
|
122 |
111 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
191 |
187 |
$2K |
| D2330 |
|
65 |
29 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
27 |
12 |
$1K |
| D2335 |
|
20 |
13 |
$710.20 |
| D0603 |
|
12,960 |
12,387 |
$0.00 |
| D0602 |
|
126 |
126 |
$0.00 |