| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,460 |
14,387 |
$556K |
| D0120 |
Periodic oral evaluation - established patient |
14,957 |
14,873 |
$495K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,687 |
2,801 |
$443K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,024 |
1,415 |
$336K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,702 |
2,729 |
$332K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,533 |
2,362 |
$310K |
| D1110 |
Prophylaxis - adult |
4,121 |
4,108 |
$302K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,096 |
12,085 |
$277K |
| D0140 |
Limited oral evaluation - problem focused |
3,498 |
3,432 |
$210K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,916 |
2,888 |
$165K |
| D0272 |
Bitewings - two radiographic images |
5,923 |
5,886 |
$124K |
| D1351 |
Sealant - per tooth |
4,608 |
1,670 |
$114K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
697 |
622 |
$100K |
| D0220 |
Intraoral - periapical first radiographic image |
6,920 |
6,764 |
$98K |
| D1206 |
Topical application of fluoride varnish |
3,685 |
3,620 |
$86K |
| D0274 |
Bitewings - four radiographic images |
2,673 |
2,661 |
$71K |
| D0210 |
Intraoral - complete series of radiographic images |
1,775 |
1,722 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,974 |
3,783 |
$47K |
| D2330 |
|
357 |
288 |
$27K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
209 |
192 |
$24K |
| D0145 |
Oral evaluation for a patient under three years of age |
780 |
780 |
$21K |
| D1354 |
|
741 |
292 |
$15K |
| D0330 |
Panoramic radiographic image |
207 |
199 |
$11K |
| D0240 |
|
540 |
312 |
$11K |
| D1510 |
|
57 |
50 |
$10K |
| D2335 |
|
63 |
51 |
$10K |
| D9248 |
|
150 |
143 |
$8K |
| D2940 |
|
92 |
71 |
$7K |
| D4355 |
|
54 |
54 |
$6K |
| D2933 |
|
41 |
27 |
$5K |
| D2390 |
|
27 |
12 |
$5K |
| D2331 |
|
50 |
37 |
$5K |
| D0270 |
|
291 |
287 |
$2K |
| D1352 |
|
33 |
26 |
$1K |
| D3910 |
|
76 |
71 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,559 |
3,433 |
$0.00 |