| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
24,755 |
24,395 |
$864K |
| D0120 |
Periodic oral evaluation - established patient |
20,756 |
20,422 |
$561K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,807 |
1,560 |
$358K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,369 |
15,073 |
$293K |
| D1206 |
Topical application of fluoride varnish |
11,355 |
11,250 |
$289K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,549 |
1,907 |
$287K |
| D0272 |
Bitewings - two radiographic images |
11,195 |
10,975 |
$233K |
| D1351 |
Sealant - per tooth |
7,493 |
2,736 |
$219K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,388 |
4,351 |
$213K |
| D9248 |
|
2,216 |
1,316 |
$163K |
| D1110 |
Prophylaxis - adult |
3,529 |
3,456 |
$160K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,403 |
3,127 |
$142K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,523 |
902 |
$132K |
| D0220 |
Intraoral - periapical first radiographic image |
8,213 |
7,970 |
$117K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,648 |
1,176 |
$105K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,798 |
2,554 |
$96K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,491 |
858 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,854 |
5,312 |
$70K |
| D0140 |
Limited oral evaluation - problem focused |
1,650 |
1,591 |
$22K |
| D1510 |
|
21 |
13 |
$3K |
| D2330 |
|
18 |
12 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D1999 |
|
16 |
12 |
$50.00 |