| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
34,272 |
32,812 |
$871K |
| D0120 |
Periodic oral evaluation - established patient |
31,969 |
30,581 |
$530K |
| D1206 |
Topical application of fluoride varnish |
41,096 |
39,226 |
$504K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,989 |
1,231 |
$428K |
| D0272 |
Bitewings - two radiographic images |
17,443 |
16,668 |
$230K |
| D1110 |
Prophylaxis - adult |
5,882 |
5,589 |
$160K |
| D1351 |
Sealant - per tooth |
9,860 |
2,672 |
$148K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,908 |
4,654 |
$130K |
| D0140 |
Limited oral evaluation - problem focused |
4,658 |
4,380 |
$112K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,701 |
1,167 |
$80K |
| D0330 |
Panoramic radiographic image |
2,886 |
2,704 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
9,025 |
8,207 |
$77K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,417 |
489 |
$76K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,133 |
4,710 |
$75K |
| D0240 |
|
9,922 |
5,268 |
$69K |
| D0274 |
Bitewings - four radiographic images |
3,647 |
3,456 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,122 |
529 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,731 |
1,758 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
770 |
751 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
330 |
255 |
$14K |
| D1354 |
|
1,002 |
279 |
$8K |
| D2929 |
|
39 |
12 |
$5K |
| D3230 |
|
37 |
12 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
63 |
63 |
$3K |
| D0350 |
|
57 |
53 |
$679.84 |
| D0270 |
|
13 |
13 |
$123.33 |
| D9995 |
|
12 |
12 |
$91.22 |