| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,161 |
11,888 |
$602K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,882 |
2,130 |
$321K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,930 |
1,849 |
$265K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,878 |
6,757 |
$192K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,336 |
12,048 |
$189K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,504 |
1,327 |
$134K |
| D0272 |
Bitewings - two radiographic images |
5,873 |
5,715 |
$108K |
| D1110 |
Prophylaxis - adult |
2,174 |
2,078 |
$101K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
874 |
422 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
3,375 |
3,220 |
$62K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,661 |
1,580 |
$57K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
834 |
365 |
$55K |
| D9110 |
|
1,275 |
1,222 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,980 |
2,853 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
282 |
277 |
$18K |
| D9420 |
|
201 |
196 |
$13K |
| D2332 |
|
126 |
68 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,279 |
1,118 |
$10K |
| D1351 |
Sealant - per tooth |
434 |
149 |
$8K |
| D0330 |
Panoramic radiographic image |
199 |
192 |
$7K |
| D1354 |
|
597 |
186 |
$6K |
| D0274 |
Bitewings - four radiographic images |
173 |
167 |
$5K |
| D2330 |
|
96 |
53 |
$5K |
| D2335 |
|
27 |
14 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
14 |
$2K |
| D9986 |
|
25 |
24 |
$18.00 |
| D1999 |
|
74 |
63 |
$0.00 |