| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
27,696 |
27,109 |
$631K |
| D0120 |
Periodic oral evaluation - established patient |
25,684 |
25,222 |
$390K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,224 |
2,925 |
$370K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,281 |
875 |
$239K |
| D0272 |
Bitewings - two radiographic images |
18,631 |
18,218 |
$232K |
| D1206 |
Topical application of fluoride varnish |
13,873 |
13,686 |
$165K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,078 |
15,669 |
$163K |
| D1351 |
Sealant - per tooth |
8,713 |
2,538 |
$129K |
| D0274 |
Bitewings - four radiographic images |
5,334 |
5,253 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,450 |
3,338 |
$80K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,551 |
4,334 |
$63K |
| D1110 |
Prophylaxis - adult |
2,283 |
2,252 |
$58K |
| D0240 |
|
6,359 |
3,683 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
6,094 |
5,818 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,050 |
636 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
2,124 |
2,061 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
828 |
411 |
$38K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
613 |
254 |
$35K |
| D1354 |
|
2,310 |
546 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,148 |
1,755 |
$21K |
| D9248 |
|
352 |
337 |
$16K |
| D0330 |
Panoramic radiographic image |
251 |
246 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
76 |
40 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
223 |
219 |
$4K |
| D2332 |
|
45 |
26 |
$2K |