| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
25,707 |
25,452 |
$262K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,597 |
4,248 |
$191K |
| D0120 |
Periodic oral evaluation - established patient |
27,985 |
27,706 |
$185K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,241 |
1,022 |
$155K |
| D1208 |
Topical application of fluoride, excluding varnish |
31,173 |
30,855 |
$147K |
| D0220 |
Intraoral - periapical first radiographic image |
31,221 |
30,509 |
$105K |
| D0274 |
Bitewings - four radiographic images |
13,998 |
13,823 |
$100K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32,195 |
28,944 |
$97K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,826 |
2,601 |
$78K |
| D1110 |
Prophylaxis - adult |
6,746 |
6,679 |
$72K |
| D0272 |
Bitewings - two radiographic images |
11,934 |
11,750 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,595 |
1,435 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,420 |
4,382 |
$48K |
| D1351 |
Sealant - per tooth |
8,100 |
2,462 |
$45K |
| D0330 |
Panoramic radiographic image |
4,379 |
4,293 |
$41K |
| D1354 |
|
6,577 |
2,010 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,479 |
6,247 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,942 |
1,900 |
$19K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
707 |
294 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
723 |
490 |
$17K |
| D3120 |
|
5,020 |
1,817 |
$16K |
| D9248 |
|
885 |
853 |
$16K |
| D2332 |
|
134 |
74 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
462 |
448 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
103 |
102 |
$782.38 |
| D1206 |
Topical application of fluoride varnish |
131 |
131 |
$473.31 |
| D0602 |
|
537 |
533 |
$0.00 |
| D9920 |
|
83 |
78 |
$0.00 |
| D0000 |
|
27 |
14 |
$0.00 |