| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,334 |
12,294 |
$539K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,007 |
3,093 |
$396K |
| D1206 |
Topical application of fluoride varnish |
11,926 |
11,883 |
$370K |
| D1351 |
Sealant - per tooth |
13,109 |
3,193 |
$284K |
| D9999 |
Unspecified adjunctive procedure, by report |
700 |
673 |
$274K |
| D0120 |
Periodic oral evaluation - established patient |
10,537 |
10,496 |
$273K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,819 |
1,008 |
$180K |
| D9248 |
|
838 |
725 |
$177K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,398 |
1,521 |
$129K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,974 |
4,723 |
$124K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,112 |
1,259 |
$105K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,324 |
772 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,717 |
2,713 |
$65K |
| D0272 |
Bitewings - two radiographic images |
5,094 |
5,078 |
$53K |
| D0140 |
Limited oral evaluation - problem focused |
1,069 |
1,055 |
$47K |
| D0240 |
|
2,229 |
2,208 |
$39K |
| D1110 |
Prophylaxis - adult |
743 |
736 |
$30K |
| D0330 |
Panoramic radiographic image |
662 |
662 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,410 |
1,405 |
$21K |
| D0603 |
|
2,271 |
2,257 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
3,210 |
3,184 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,406 |
2,382 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
824 |
823 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
146 |
124 |
$11K |
| D0602 |
|
1,300 |
1,296 |
$11K |
| D0601 |
|
1,248 |
1,244 |
$11K |
| D2332 |
|
117 |
78 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
133 |
133 |
$6K |
| D1510 |
|
48 |
40 |
$3K |
| D9920 |
|
154 |
142 |
$3K |
| D2331 |
|
17 |
14 |
$840.00 |
| D2330 |
|
20 |
12 |
$800.00 |
| D9420 |
|
14 |
14 |
$165.00 |
| D1330 |
|
21 |
21 |
$0.00 |