| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
19,045 |
18,723 |
$783K |
| D1206 |
Topical application of fluoride varnish |
18,750 |
18,428 |
$489K |
| D0120 |
Periodic oral evaluation - established patient |
17,018 |
16,708 |
$478K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,103 |
3,708 |
$185K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,654 |
1,349 |
$143K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,496 |
1,286 |
$107K |
| D0274 |
Bitewings - four radiographic images |
4,295 |
4,216 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
11,286 |
11,014 |
$68K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
584 |
488 |
$59K |
| D7140 |
Extraction, erupted tooth or exposed root |
977 |
861 |
$58K |
| D0272 |
Bitewings - two radiographic images |
5,532 |
5,416 |
$56K |
| D1351 |
Sealant - per tooth |
627 |
367 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,088 |
2,059 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,206 |
9,972 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
495 |
436 |
$22K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
330 |
276 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
899 |
868 |
$15K |
| D9310 |
|
110 |
105 |
$2K |
| D1999 |
|
1,083 |
889 |
$0.00 |