| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,098 |
11,894 |
$278K |
| D1206 |
Topical application of fluoride varnish |
12,029 |
11,822 |
$192K |
| D0120 |
Periodic oral evaluation - established patient |
10,049 |
9,865 |
$152K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,850 |
2,278 |
$134K |
| D1351 |
Sealant - per tooth |
9,319 |
2,105 |
$123K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,860 |
1,198 |
$71K |
| D0272 |
Bitewings - two radiographic images |
6,377 |
6,252 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,249 |
3,660 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
789 |
498 |
$24K |
| D0601 |
|
4,158 |
4,067 |
$21K |
| D0603 |
|
5,048 |
4,934 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,920 |
1,892 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
604 |
581 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
4,983 |
4,852 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
164 |
112 |
$7K |
| D0274 |
Bitewings - four radiographic images |
1,074 |
1,030 |
$6K |
| D1110 |
Prophylaxis - adult |
197 |
177 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,518 |
3,098 |
$5K |
| D0330 |
Panoramic radiographic image |
465 |
463 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
47 |
41 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
22 |
16 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
89 |
89 |
$606.98 |
| D0145 |
Oral evaluation for a patient under three years of age |
28 |
28 |
$233.75 |
| D0602 |
|
115 |
115 |
$56.32 |
| D0240 |
|
12 |
12 |
$12.75 |
| D1330 |
|
5,881 |
5,656 |
$0.00 |
| D1310 |
|
3,187 |
3,094 |
$0.00 |
| D1999 |
|
1,312 |
1,255 |
$0.00 |
| D8660 |
|
58 |
31 |
$0.00 |