| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,518 |
7,451 |
$386K |
| D1206 |
Topical application of fluoride varnish |
8,081 |
8,020 |
$215K |
| D0120 |
Periodic oral evaluation - established patient |
6,031 |
5,989 |
$180K |
| D7962 |
|
358 |
355 |
$124K |
| D7961 |
|
335 |
329 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,880 |
1,866 |
$110K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
799 |
454 |
$92K |
| D0272 |
Bitewings - two radiographic images |
2,730 |
2,709 |
$83K |
| D1351 |
Sealant - per tooth |
1,533 |
527 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
2,034 |
1,990 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,346 |
1,260 |
$27K |
| D1110 |
Prophylaxis - adult |
323 |
321 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,680 |
895 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
100 |
43 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
322 |
318 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
146 |
70 |
$15K |
| D1354 |
|
1,120 |
347 |
$15K |
| D0330 |
Panoramic radiographic image |
152 |
151 |
$13K |
| D0274 |
Bitewings - four radiographic images |
218 |
217 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
82 |
65 |
$8K |
| D9110 |
|
57 |
54 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
31 |
14 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
21 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
58 |
57 |
$2K |
| D1999 |
|
684 |
635 |
$0.00 |