| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
23,860 |
23,377 |
$788K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,684 |
1,605 |
$710K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,615 |
5,147 |
$635K |
| D1206 |
Topical application of fluoride varnish |
26,533 |
25,982 |
$547K |
| D0120 |
Periodic oral evaluation - established patient |
21,383 |
20,953 |
$503K |
| D9248 |
|
2,910 |
2,751 |
$244K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,070 |
12,026 |
$204K |
| D0272 |
Bitewings - two radiographic images |
11,710 |
11,481 |
$192K |
| D0220 |
Intraoral - periapical first radiographic image |
15,773 |
15,281 |
$187K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,029 |
1,418 |
$169K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,273 |
4,056 |
$120K |
| D0330 |
Panoramic radiographic image |
2,660 |
2,603 |
$114K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,549 |
839 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,618 |
2,565 |
$74K |
| D1110 |
Prophylaxis - adult |
1,306 |
1,277 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,324 |
1,299 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
437 |
359 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
979 |
956 |
$21K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
74 |
41 |
$6K |
| D2934 |
|
59 |
12 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
123 |
122 |
$3K |