| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
20,132 |
20,026 |
$892K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,096 |
4,832 |
$747K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,612 |
4,931 |
$667K |
| D0120 |
Periodic oral evaluation - established patient |
17,939 |
17,847 |
$599K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,452 |
16,368 |
$459K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,403 |
5,954 |
$368K |
| D0240 |
|
14,470 |
7,981 |
$293K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,395 |
1,136 |
$272K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,850 |
4,981 |
$245K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,349 |
1,096 |
$173K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,346 |
946 |
$146K |
| D0274 |
Bitewings - four radiographic images |
3,113 |
3,102 |
$144K |
| D1351 |
Sealant - per tooth |
3,370 |
1,565 |
$129K |
| D0272 |
Bitewings - two radiographic images |
3,557 |
3,541 |
$110K |
| D0220 |
Intraoral - periapical first radiographic image |
5,433 |
5,403 |
$100K |
| D7111 |
|
1,047 |
697 |
$90K |
| D1206 |
Topical application of fluoride varnish |
3,157 |
3,139 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,114 |
1,114 |
$70K |
| D0330 |
Panoramic radiographic image |
517 |
514 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
428 |
424 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
98 |
73 |
$14K |