| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
35,350 |
34,831 |
$405K |
| D0120 |
Periodic oral evaluation - established patient |
41,384 |
40,778 |
$295K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,689 |
4,913 |
$243K |
| D1208 |
Topical application of fluoride, excluding varnish |
42,256 |
41,630 |
$213K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,340 |
2,285 |
$198K |
| D0272 |
Bitewings - two radiographic images |
22,168 |
21,806 |
$134K |
| D1351 |
Sealant - per tooth |
16,538 |
4,242 |
$131K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,964 |
3,306 |
$119K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,681 |
2,683 |
$118K |
| D1110 |
Prophylaxis - adult |
9,570 |
9,442 |
$110K |
| D0220 |
Intraoral - periapical first radiographic image |
26,849 |
26,209 |
$102K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,296 |
1,954 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,773 |
4,690 |
$69K |
| D0330 |
Panoramic radiographic image |
4,999 |
4,854 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,791 |
16,305 |
$59K |
| D9248 |
|
2,588 |
2,433 |
$57K |
| D0274 |
Bitewings - four radiographic images |
7,557 |
7,436 |
$57K |
| D1206 |
Topical application of fluoride varnish |
3,851 |
3,808 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,490 |
3,341 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
2,356 |
2,306 |
$23K |
| D0240 |
|
2,731 |
1,799 |
$17K |
| D3120 |
|
1,922 |
1,205 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
736 |
732 |
$7K |
| D1354 |
|
828 |
144 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
25 |
15 |
$784.52 |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
29 |
$189.75 |
| D0602 |
|
1,247 |
1,235 |
$0.00 |
| D0603 |
|
5,537 |
5,412 |
$0.00 |
| D0601 |
|
251 |
249 |
$0.00 |