| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
15,713 |
15,663 |
$663K |
| D0120 |
Periodic oral evaluation - established patient |
14,888 |
14,851 |
$642K |
| D1206 |
Topical application of fluoride varnish |
15,998 |
15,947 |
$480K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,804 |
1,536 |
$319K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,605 |
1,504 |
$265K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,846 |
1,207 |
$195K |
| D0272 |
Bitewings - two radiographic images |
5,706 |
5,667 |
$167K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
963 |
488 |
$154K |
| D0274 |
Bitewings - four radiographic images |
4,867 |
4,856 |
$148K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,263 |
3,258 |
$140K |
| D1110 |
Prophylaxis - adult |
2,614 |
2,608 |
$135K |
| D1351 |
Sealant - per tooth |
2,758 |
860 |
$111K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,153 |
836 |
$106K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,009 |
5,605 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
6,597 |
6,535 |
$92K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,455 |
4,966 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
1,486 |
1,459 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
685 |
683 |
$51K |
| D0602 |
|
5,116 |
5,094 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
323 |
239 |
$38K |
| D0330 |
Panoramic radiographic image |
746 |
745 |
$32K |
| D0240 |
|
1,472 |
1,005 |
$28K |
| D0601 |
|
3,294 |
3,271 |
$26K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
256 |
174 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
483 |
483 |
$11K |
| D0603 |
|
836 |
833 |
$7K |
| D9420 |
|
12 |
12 |
$4K |
| D2140 |
|
17 |
13 |
$2K |
| D9310 |
|
36 |
36 |
$720.00 |
| D0273 |
|
25 |
25 |
$601.62 |
| D1330 |
|
3,072 |
3,020 |
$0.00 |
| D1999 |
|
11,430 |
10,915 |
$0.00 |