| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
18,635 |
17,921 |
$877K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
20,970 |
20,152 |
$534K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,809 |
2,840 |
$445K |
| D0272 |
Bitewings - two radiographic images |
15,214 |
14,575 |
$262K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,956 |
16,291 |
$242K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,815 |
699 |
$201K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,126 |
1,634 |
$159K |
| D0330 |
Panoramic radiographic image |
3,567 |
3,393 |
$135K |
| D1351 |
Sealant - per tooth |
6,210 |
1,788 |
$114K |
| D1110 |
Prophylaxis - adult |
2,442 |
2,319 |
$113K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,094 |
2,856 |
$105K |
| D0220 |
Intraoral - periapical first radiographic image |
8,264 |
7,891 |
$82K |
| D7111 |
|
1,571 |
824 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,021 |
6,135 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
778 |
345 |
$52K |
| D1206 |
Topical application of fluoride varnish |
3,300 |
3,201 |
$51K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
508 |
236 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
714 |
695 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
765 |
761 |
$20K |
| D9248 |
|
164 |
156 |
$18K |
| D9110 |
|
440 |
424 |
$11K |
| D2330 |
|
114 |
54 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
50 |
25 |
$4K |
| D3110 |
|
166 |
84 |
$3K |
| D9420 |
|
71 |
51 |
$3K |
| D0274 |
Bitewings - four radiographic images |
41 |
40 |
$1K |
| D9986 |
|
512 |
382 |
$0.00 |