| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,255 |
12,234 |
$557K |
| D1206 |
Topical application of fluoride varnish |
14,067 |
14,040 |
$508K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,269 |
3,163 |
$291K |
| D0120 |
Periodic oral evaluation - established patient |
10,684 |
10,656 |
$273K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,965 |
1,218 |
$216K |
| D0274 |
Bitewings - four radiographic images |
8,657 |
8,635 |
$204K |
| D1351 |
Sealant - per tooth |
8,095 |
1,772 |
$191K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,607 |
2,300 |
$155K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,878 |
1,620 |
$120K |
| D0240 |
|
4,225 |
4,137 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,664 |
2,660 |
$88K |
| D1110 |
Prophylaxis - adult |
1,831 |
1,825 |
$83K |
| D0220 |
Intraoral - periapical first radiographic image |
5,863 |
5,848 |
$82K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,657 |
8,422 |
$80K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,517 |
710 |
$74K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,792 |
2,719 |
$52K |
| D9420 |
|
1,075 |
1,066 |
$44K |
| D0603 |
|
8,149 |
8,142 |
$41K |
| D9999 |
Unspecified adjunctive procedure, by report |
708 |
708 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
600 |
596 |
$20K |
| D0999 |
Unspecified diagnostic procedure, by report |
554 |
554 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
706 |
705 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
184 |
141 |
$11K |
| D2330 |
|
140 |
91 |
$8K |
| D2933 |
|
68 |
25 |
$8K |
| D0272 |
Bitewings - two radiographic images |
202 |
202 |
$4K |
| D1999 |
|
144 |
144 |
$2K |
| D3120 |
|
69 |
56 |
$1K |
| D0350 |
|
39 |
13 |
$0.00 |