| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,587 |
12,305 |
$185K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,609 |
2,039 |
$168K |
| D0120 |
Periodic oral evaluation - established patient |
12,176 |
11,905 |
$117K |
| D1206 |
Topical application of fluoride varnish |
14,204 |
13,889 |
$103K |
| D0272 |
Bitewings - two radiographic images |
11,996 |
11,707 |
$95K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,919 |
680 |
$76K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,169 |
523 |
$64K |
| D1351 |
Sealant - per tooth |
5,374 |
1,463 |
$53K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,270 |
590 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,987 |
1,939 |
$29K |
| D1110 |
Prophylaxis - adult |
1,722 |
1,676 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
2,064 |
1,887 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
688 |
317 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
821 |
406 |
$20K |
| D0274 |
Bitewings - four radiographic images |
1,741 |
1,691 |
$17K |
| D9248 |
|
508 |
453 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,540 |
1,377 |
$12K |
| D0330 |
Panoramic radiographic image |
891 |
848 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
2,464 |
2,339 |
$10K |
| D0240 |
|
1,674 |
970 |
$10K |
| D2330 |
|
196 |
68 |
$5K |
| D1999 |
|
3,271 |
3,097 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
118 |
107 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
213 |
207 |
$2K |
| D2332 |
|
29 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
568 |
516 |
$2K |
| D0602 |
|
7,068 |
6,781 |
$0.00 |