| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,142 |
11,979 |
$610K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,222 |
1,866 |
$397K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,904 |
469 |
$353K |
| D1206 |
Topical application of fluoride varnish |
13,061 |
12,868 |
$340K |
| D0120 |
Periodic oral evaluation - established patient |
11,480 |
11,323 |
$332K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,473 |
605 |
$162K |
| D0272 |
Bitewings - two radiographic images |
4,544 |
4,464 |
$135K |
| D0330 |
Panoramic radiographic image |
1,597 |
1,566 |
$132K |
| D1351 |
Sealant - per tooth |
2,870 |
851 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,857 |
1,828 |
$104K |
| D1110 |
Prophylaxis - adult |
1,044 |
1,009 |
$69K |
| D0140 |
Limited oral evaluation - problem focused |
1,470 |
1,397 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,478 |
1,455 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
2,933 |
2,754 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,237 |
3,076 |
$53K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
451 |
163 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,847 |
1,382 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
246 |
130 |
$21K |
| D0240 |
|
779 |
383 |
$18K |
| D9248 |
|
197 |
176 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
126 |
126 |
$4K |
| D9920 |
|
310 |
235 |
$3K |
| D1330 |
|
998 |
971 |
$0.00 |