| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
27,346 |
27,301 |
$1.19M |
| D1208 |
Topical application of fluoride, excluding varnish |
32,672 |
32,623 |
$851K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,010 |
4,865 |
$841K |
| D0120 |
Periodic oral evaluation - established patient |
28,663 |
28,619 |
$802K |
| D1351 |
Sealant - per tooth |
5,932 |
2,630 |
$324K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,775 |
2,369 |
$282K |
| D1110 |
Prophylaxis - adult |
5,354 |
5,347 |
$242K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,221 |
1,741 |
$216K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
879 |
825 |
$164K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,925 |
3,921 |
$149K |
| D0272 |
Bitewings - two radiographic images |
9,088 |
9,080 |
$147K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
985 |
913 |
$138K |
| D0220 |
Intraoral - periapical first radiographic image |
10,190 |
10,172 |
$125K |
| D0210 |
Intraoral - complete series of radiographic images |
8,092 |
8,076 |
$91K |
| D0330 |
Panoramic radiographic image |
2,006 |
2,001 |
$86K |
| D9990 |
|
3,614 |
3,517 |
$79K |
| D0274 |
Bitewings - four radiographic images |
2,042 |
2,042 |
$51K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
255 |
239 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
678 |
673 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
100 |
98 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,083 |
1,083 |
$11K |
| D1354 |
|
649 |
173 |
$10K |
| D1206 |
Topical application of fluoride varnish |
373 |
371 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
167 |
167 |
$5K |
| D2140 |
|
18 |
18 |
$1K |
| D2330 |
|
15 |
13 |
$1K |
| D9430 |
|
32 |
31 |
$541.80 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
215 |
212 |
$0.00 |