| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
18,704 |
18,094 |
$173K |
| D0120 |
Periodic oral evaluation - established patient |
22,506 |
21,849 |
$136K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,287 |
2,943 |
$127K |
| D1208 |
Topical application of fluoride, excluding varnish |
24,434 |
23,627 |
$108K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,518 |
878 |
$76K |
| D1110 |
Prophylaxis - adult |
5,789 |
5,624 |
$66K |
| D0272 |
Bitewings - two radiographic images |
13,209 |
12,811 |
$57K |
| D0274 |
Bitewings - four radiographic images |
6,438 |
6,212 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
10,955 |
10,521 |
$38K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,691 |
705 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,639 |
935 |
$33K |
| D1351 |
Sealant - per tooth |
4,481 |
1,206 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,877 |
9,190 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,030 |
1,939 |
$24K |
| D0330 |
Panoramic radiographic image |
3,541 |
3,438 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
1,828 |
1,735 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
703 |
437 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,157 |
2,886 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
369 |
361 |
$8K |
| D9248 |
|
529 |
476 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
509 |
316 |
$7K |
| D1999 |
|
8,476 |
7,246 |
$6K |
| D2330 |
|
44 |
29 |
$220.68 |
| D0270 |
|
17 |
17 |
$81.35 |
| D0602 |
|
2,245 |
2,052 |
$0.00 |
| D0603 |
|
3,456 |
3,134 |
$0.00 |
| D0601 |
|
4,776 |
4,287 |
$0.00 |
| D9995 |
|
16 |
12 |
$0.00 |