| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
24,323 |
23,747 |
$793K |
| D0120 |
Periodic oral evaluation - established patient |
24,086 |
23,519 |
$565K |
| D1206 |
Topical application of fluoride varnish |
27,192 |
26,583 |
$559K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,420 |
2,979 |
$481K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,995 |
4,873 |
$354K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,801 |
10,070 |
$310K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,227 |
2,639 |
$229K |
| D1110 |
Prophylaxis - adult |
4,810 |
4,702 |
$200K |
| D0272 |
Bitewings - two radiographic images |
11,260 |
10,975 |
$194K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,123 |
2,038 |
$182K |
| D0330 |
Panoramic radiographic image |
4,131 |
4,037 |
$178K |
| D1351 |
Sealant - per tooth |
5,488 |
1,661 |
$164K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,141 |
5,029 |
$147K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,122 |
793 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
3,642 |
3,522 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,609 |
1,551 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,127 |
1,113 |
$29K |
| D1354 |
|
1,876 |
500 |
$18K |
| D3240 |
|
254 |
148 |
$14K |
| D2330 |
|
183 |
122 |
$11K |
| D2332 |
|
89 |
63 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
121 |
114 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
69 |
50 |
$621.82 |
| D1208 |
Topical application of fluoride, excluding varnish |
16 |
16 |
$362.85 |
| D9430 |
|
13 |
13 |
$0.00 |
| D1999 |
|
1,241 |
1,194 |
$0.00 |
| D9310 |
|
26 |
26 |
$0.00 |