| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
30,054 |
29,948 |
$954K |
| D1208 |
Topical application of fluoride, excluding varnish |
30,857 |
30,740 |
$561K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15,123 |
15,077 |
$530K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,113 |
3,385 |
$372K |
| D0120 |
Periodic oral evaluation - established patient |
15,642 |
15,598 |
$357K |
| D0272 |
Bitewings - two radiographic images |
9,839 |
9,812 |
$202K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,367 |
2,302 |
$187K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,716 |
6,483 |
$184K |
| D0274 |
Bitewings - four radiographic images |
6,015 |
6,002 |
$178K |
| D0220 |
Intraoral - periapical first radiographic image |
14,930 |
14,841 |
$170K |
| D1351 |
Sealant - per tooth |
5,319 |
1,555 |
$127K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,661 |
13,449 |
$125K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
871 |
621 |
$104K |
| D0330 |
Panoramic radiographic image |
1,851 |
1,846 |
$94K |
| D0140 |
Limited oral evaluation - problem focused |
2,534 |
2,481 |
$76K |
| D1110 |
Prophylaxis - adult |
837 |
834 |
$40K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
253 |
197 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
266 |
197 |
$18K |
| D0240 |
|
1,315 |
832 |
$18K |
| D9248 |
|
597 |
581 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
147 |
138 |
$13K |
| D7111 |
|
22 |
14 |
$1K |
| D2330 |
|
13 |
12 |
$901.78 |
| D1999 |
|
54 |
46 |
$0.00 |