| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,335 |
8,992 |
$218K |
| D1206 |
Topical application of fluoride varnish |
7,547 |
7,213 |
$125K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,468 |
1,645 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
6,755 |
6,542 |
$87K |
| D1351 |
Sealant - per tooth |
5,228 |
1,223 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,132 |
2,996 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,497 |
1,045 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,513 |
1,018 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,858 |
1,855 |
$28K |
| D0601 |
|
4,336 |
4,153 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
1,068 |
994 |
$20K |
| D1110 |
Prophylaxis - adult |
817 |
780 |
$16K |
| D9920 |
|
1,000 |
908 |
$16K |
| D0603 |
|
2,025 |
1,922 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
4,552 |
4,291 |
$12K |
| D0272 |
Bitewings - two radiographic images |
2,375 |
2,311 |
$12K |
| D0602 |
|
1,775 |
1,720 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
456 |
438 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,813 |
3,260 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
246 |
240 |
$6K |
| D0274 |
Bitewings - four radiographic images |
450 |
439 |
$3K |
| D0330 |
Panoramic radiographic image |
168 |
160 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
65 |
58 |
$935.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
14 |
13 |
$450.00 |
| D1354 |
|
53 |
18 |
$235.00 |
| D1999 |
|
13,882 |
12,127 |
$0.00 |
| D1330 |
|
5,981 |
5,544 |
$0.00 |
| D1310 |
|
5,597 |
5,210 |
$0.00 |
| D1355 |
|
415 |
49 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
43 |
43 |
$0.00 |