| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,531 |
9,515 |
$408K |
| D1351 |
Sealant - per tooth |
15,805 |
4,108 |
$304K |
| D1206 |
Topical application of fluoride varnish |
9,852 |
9,836 |
$300K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,319 |
2,154 |
$297K |
| D0120 |
Periodic oral evaluation - established patient |
8,842 |
8,832 |
$219K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,119 |
531 |
$111K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,835 |
3,775 |
$99K |
| D1353 |
|
9,791 |
2,408 |
$86K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,262 |
649 |
$77K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,247 |
780 |
$67K |
| D0272 |
Bitewings - two radiographic images |
4,813 |
4,803 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
8,413 |
8,384 |
$39K |
| D0603 |
|
4,262 |
4,252 |
$35K |
| D0274 |
Bitewings - four radiographic images |
2,375 |
2,374 |
$30K |
| D1110 |
Prophylaxis - adult |
636 |
636 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,026 |
7,975 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
283 |
212 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
512 |
507 |
$22K |
| D0145 |
Oral evaluation for a patient under three years of age |
390 |
389 |
$17K |
| D9920 |
|
673 |
659 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
490 |
488 |
$12K |
| D0601 |
|
577 |
574 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
40 |
28 |
$3K |
| D0602 |
|
165 |
165 |
$2K |
| D0240 |
|
60 |
29 |
$684.00 |