| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,251 |
13,214 |
$392K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,870 |
2,131 |
$290K |
| D1206 |
Topical application of fluoride varnish |
12,601 |
11,745 |
$274K |
| D0120 |
Periodic oral evaluation - established patient |
14,844 |
13,789 |
$272K |
| D1999 |
|
12,982 |
11,196 |
$182K |
| D0272 |
Bitewings - two radiographic images |
9,927 |
9,143 |
$150K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,417 |
572 |
$125K |
| D1110 |
Prophylaxis - adult |
3,042 |
2,864 |
$112K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,374 |
4,561 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,258 |
3,038 |
$99K |
| D0330 |
Panoramic radiographic image |
2,108 |
1,958 |
$97K |
| D1351 |
Sealant - per tooth |
4,351 |
825 |
$61K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
910 |
647 |
$58K |
| D0240 |
|
7,972 |
1,489 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,780 |
1,654 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
633 |
341 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,630 |
1,480 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
765 |
683 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,021 |
1,741 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
230 |
101 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
94 |
69 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
312 |
298 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
538 |
267 |
$3K |
| D2331 |
|
19 |
12 |
$1K |
| D0602 |
|
37 |
36 |
$0.00 |
| D0603 |
|
175 |
171 |
$0.00 |
| D0601 |
|
36 |
36 |
$0.00 |