| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,113 |
13,525 |
$462K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,491 |
3,107 |
$383K |
| D1206 |
Topical application of fluoride varnish |
17,029 |
16,338 |
$349K |
| D0120 |
Periodic oral evaluation - established patient |
13,454 |
12,867 |
$320K |
| D1351 |
Sealant - per tooth |
6,822 |
2,056 |
$186K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,511 |
6,019 |
$184K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,973 |
1,745 |
$175K |
| D1110 |
Prophylaxis - adult |
2,722 |
2,628 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,809 |
3,673 |
$106K |
| D0272 |
Bitewings - two radiographic images |
5,624 |
5,399 |
$93K |
| D1354 |
|
9,949 |
2,510 |
$92K |
| D0330 |
Panoramic radiographic image |
2,289 |
2,175 |
$90K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,067 |
806 |
$84K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,537 |
976 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
6,075 |
5,791 |
$73K |
| D2394 |
|
705 |
522 |
$58K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
478 |
344 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,399 |
5,103 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,924 |
1,853 |
$48K |
| D1353 |
|
1,282 |
411 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
875 |
821 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
479 |
468 |
$12K |
| D2330 |
|
164 |
109 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
95 |
47 |
$6K |
| D2335 |
|
68 |
47 |
$5K |
| D2332 |
|
58 |
43 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
45 |
45 |
$3K |
| D2940 |
|
57 |
27 |
$2K |
| D1352 |
|
59 |
27 |
$1K |
| D3110 |
|
14 |
12 |
$80.34 |
| D3120 |
|
13 |
12 |
$39.14 |
| D7111 |
|
170 |
101 |
$0.00 |