| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,144 |
15,886 |
$678K |
| D1351 |
Sealant - per tooth |
18,143 |
4,214 |
$597K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,251 |
2,340 |
$511K |
| D0120 |
Periodic oral evaluation - established patient |
16,812 |
16,563 |
$486K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,247 |
1,805 |
$332K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,560 |
13,380 |
$310K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,277 |
2,046 |
$304K |
| D1110 |
Prophylaxis - adult |
3,989 |
3,928 |
$230K |
| D0272 |
Bitewings - two radiographic images |
12,375 |
12,200 |
$194K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,080 |
712 |
$169K |
| D1206 |
Topical application of fluoride varnish |
6,514 |
6,373 |
$160K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,430 |
2,375 |
$127K |
| D9248 |
|
656 |
619 |
$122K |
| D0330 |
Panoramic radiographic image |
2,306 |
2,273 |
$98K |
| D0274 |
Bitewings - four radiographic images |
3,395 |
3,346 |
$75K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,825 |
3,637 |
$74K |
| D0140 |
Limited oral evaluation - problem focused |
1,477 |
1,418 |
$64K |
| D1330 |
|
7,573 |
7,443 |
$45K |
| D3120 |
|
1,100 |
728 |
$38K |
| D2940 |
|
328 |
250 |
$16K |
| D2335 |
|
101 |
63 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
89 |
70 |
$13K |
| D2330 |
|
102 |
70 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
412 |
395 |
$4K |
| D0240 |
|
137 |
137 |
$2K |
| D2331 |
|
17 |
14 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
15 |
12 |
$900.00 |