| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,381 |
13,795 |
$729K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,380 |
9,042 |
$257K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,920 |
15,278 |
$237K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,015 |
709 |
$229K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,703 |
1,543 |
$177K |
| D0120 |
Periodic oral evaluation - established patient |
7,393 |
7,014 |
$159K |
| D1351 |
Sealant - per tooth |
7,594 |
1,851 |
$151K |
| D0330 |
Panoramic radiographic image |
3,142 |
3,022 |
$133K |
| D0272 |
Bitewings - two radiographic images |
6,459 |
6,225 |
$117K |
| D1110 |
Prophylaxis - adult |
2,223 |
2,081 |
$110K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,728 |
1,048 |
$93K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,285 |
2,083 |
$81K |
| D0140 |
Limited oral evaluation - problem focused |
1,932 |
1,843 |
$64K |
| D0274 |
Bitewings - four radiographic images |
2,163 |
2,063 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
771 |
414 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
3,222 |
3,082 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
288 |
212 |
$23K |
| D2335 |
|
217 |
88 |
$20K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
44 |
42 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,593 |
682 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
48 |
25 |
$3K |
| D1354 |
|
195 |
68 |
$2K |
| D2330 |
|
20 |
14 |
$987.20 |
| D0270 |
|
26 |
26 |
$237.98 |
| D9420 |
|
14 |
14 |
$202.80 |
| D0603 |
|
49 |
39 |
$0.00 |
| D9987 |
|
171 |
133 |
$0.00 |
| D9986 |
|
1,513 |
1,246 |
$0.00 |