| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
28,163 |
27,683 |
$560K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,149 |
3,123 |
$524K |
| D1206 |
Topical application of fluoride varnish |
33,003 |
32,471 |
$495K |
| D0120 |
Periodic oral evaluation - established patient |
27,117 |
26,724 |
$465K |
| D1351 |
Sealant - per tooth |
13,359 |
3,875 |
$291K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,853 |
3,101 |
$280K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,238 |
2,978 |
$229K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,791 |
6,641 |
$177K |
| D1110 |
Prophylaxis - adult |
4,870 |
4,807 |
$166K |
| D0330 |
Panoramic radiographic image |
3,293 |
3,232 |
$150K |
| D0272 |
Bitewings - two radiographic images |
14,194 |
13,936 |
$129K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,390 |
1,080 |
$89K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,092 |
890 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
7,220 |
7,064 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,656 |
3,959 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,143 |
1,137 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
349 |
235 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
157 |
137 |
$11K |
| D2335 |
|
68 |
50 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
257 |
253 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
131 |
127 |
$5K |
| D2140 |
|
57 |
42 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
151 |
139 |
$1K |
| D1353 |
|
29 |
12 |
$0.00 |
| D1999 |
|
88 |
85 |
$0.00 |