| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,393 |
16,189 |
$578K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,362 |
3,618 |
$545K |
| D0120 |
Periodic oral evaluation - established patient |
12,426 |
12,261 |
$351K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,540 |
16,323 |
$332K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,604 |
6,498 |
$296K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,448 |
2,249 |
$240K |
| D0272 |
Bitewings - two radiographic images |
10,781 |
10,603 |
$228K |
| D1351 |
Sealant - per tooth |
6,379 |
1,835 |
$192K |
| D1110 |
Prophylaxis - adult |
2,839 |
2,778 |
$138K |
| D0220 |
Intraoral - periapical first radiographic image |
7,838 |
7,632 |
$113K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,139 |
6,436 |
$83K |
| D1206 |
Topical application of fluoride varnish |
2,245 |
2,223 |
$55K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
171 |
153 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
104 |
102 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
30 |
25 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16 |
13 |
$2K |
| D9986 |
|
151 |
141 |
$0.00 |