| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
40,452 |
38,746 |
$1.89M |
| D1206 |
Topical application of fluoride varnish |
45,995 |
44,066 |
$1.11M |
| D0120 |
Periodic oral evaluation - established patient |
40,548 |
38,882 |
$1.09M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,580 |
6,706 |
$861K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,666 |
5,157 |
$791K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,414 |
4,427 |
$774K |
| D1351 |
Sealant - per tooth |
12,764 |
4,761 |
$469K |
| D0272 |
Bitewings - two radiographic images |
16,420 |
15,649 |
$453K |
| D1110 |
Prophylaxis - adult |
6,391 |
6,005 |
$374K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,177 |
2,597 |
$356K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,366 |
468 |
$257K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,456 |
11,505 |
$243K |
| D0274 |
Bitewings - four radiographic images |
5,423 |
5,093 |
$211K |
| D0330 |
Panoramic radiographic image |
2,990 |
2,854 |
$204K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,017 |
2,870 |
$161K |
| D0220 |
Intraoral - periapical first radiographic image |
8,194 |
7,695 |
$146K |
| D0140 |
Limited oral evaluation - problem focused |
2,692 |
2,461 |
$110K |
| D2140 |
|
1,194 |
520 |
$79K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,849 |
3,138 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,536 |
1,341 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
290 |
236 |
$32K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
173 |
95 |
$16K |
| D0240 |
|
1,213 |
709 |
$13K |
| D3120 |
|
403 |
277 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
439 |
406 |
$10K |
| D2330 |
|
69 |
37 |
$6K |
| D2332 |
|
19 |
13 |
$2K |
| D2160 |
|
16 |
15 |
$2K |
| D2940 |
|
218 |
204 |
$200.71 |
| D9420 |
|
56 |
52 |
$0.00 |
| D0603 |
|
13,698 |
13,448 |
$0.00 |
| D0602 |
|
2,995 |
2,961 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
14 |
14 |
$0.00 |
| D0601 |
|
68 |
68 |
$0.00 |
| D9986 |
|
2,614 |
2,492 |
$0.00 |
| D9987 |
|
185 |
182 |
$0.00 |
| D1999 |
|
17 |
17 |
$0.00 |