| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
22,484 |
22,145 |
$984K |
| D0120 |
Periodic oral evaluation - established patient |
21,198 |
20,893 |
$628K |
| D1206 |
Topical application of fluoride varnish |
23,929 |
23,566 |
$593K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,723 |
2,414 |
$570K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,753 |
1,035 |
$427K |
| D9248 |
|
2,282 |
2,246 |
$417K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,520 |
1,420 |
$277K |
| D0272 |
Bitewings - two radiographic images |
9,657 |
9,514 |
$147K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,167 |
718 |
$110K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,529 |
1,502 |
$80K |
| D1110 |
Prophylaxis - adult |
1,307 |
1,289 |
$77K |
| D3120 |
|
1,721 |
1,054 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
1,128 |
1,110 |
$51K |
| D1351 |
Sealant - per tooth |
1,410 |
401 |
$49K |
| D9310 |
|
1,031 |
1,023 |
$48K |
| D0330 |
Panoramic radiographic image |
1,136 |
1,105 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,587 |
2,509 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,602 |
1,581 |
$36K |
| D0240 |
|
1,919 |
1,879 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,632 |
1,605 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
250 |
244 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
85 |
85 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
23 |
15 |
$1K |
| D0270 |
|
107 |
103 |
$900.00 |
| D9420 |
|
33 |
33 |
$495.00 |