| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,708 |
12,955 |
$561K |
| D1206 |
Topical application of fluoride varnish |
13,939 |
13,168 |
$445K |
| D1351 |
Sealant - per tooth |
14,162 |
3,314 |
$295K |
| D0120 |
Periodic oral evaluation - established patient |
10,000 |
9,459 |
$234K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,686 |
1,519 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,471 |
3,352 |
$106K |
| D0272 |
Bitewings - two radiographic images |
6,416 |
6,073 |
$103K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,265 |
4,723 |
$87K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,282 |
1,403 |
$85K |
| D0330 |
Panoramic radiographic image |
2,063 |
1,980 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,510 |
905 |
$50K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
844 |
361 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,551 |
1,470 |
$48K |
| D9999 |
Unspecified adjunctive procedure, by report |
899 |
899 |
$36K |
| D1353 |
|
2,982 |
1,116 |
$33K |
| D0240 |
|
1,460 |
1,087 |
$27K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
426 |
180 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,001 |
937 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,548 |
1,431 |
$16K |
| D0999 |
Unspecified diagnostic procedure, by report |
465 |
465 |
$14K |
| D0601 |
|
3,402 |
3,020 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
145 |
100 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
831 |
734 |
$5K |
| D0603 |
|
2,863 |
2,457 |
$5K |
| D0602 |
|
2,984 |
2,608 |
$4K |
| D1999 |
|
10,820 |
9,823 |
$2K |
| D3120 |
|
73 |
55 |
$511.50 |
| D4355 |
|
12 |
12 |
$350.00 |
| D1354 |
|
53 |
12 |
$307.50 |
| D0145 |
Oral evaluation for a patient under three years of age |
27 |
15 |
$0.00 |
| D9986 |
|
280 |
247 |
$0.00 |