| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,476 |
9,297 |
$502K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,632 |
1,481 |
$422K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,365 |
2,371 |
$296K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,006 |
6,855 |
$199K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,477 |
1,744 |
$190K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,066 |
3,649 |
$143K |
| D0330 |
Panoramic radiographic image |
2,427 |
2,370 |
$123K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,079 |
1,234 |
$113K |
| D0272 |
Bitewings - two radiographic images |
5,243 |
5,142 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
3,809 |
3,758 |
$97K |
| D1351 |
Sealant - per tooth |
4,540 |
1,633 |
$88K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,501 |
5,366 |
$84K |
| D1206 |
Topical application of fluoride varnish |
4,731 |
4,675 |
$79K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,027 |
515 |
$67K |
| D2332 |
|
659 |
354 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
512 |
377 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,474 |
3,342 |
$36K |
| D1110 |
Prophylaxis - adult |
658 |
654 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,745 |
1,684 |
$27K |
| D0274 |
Bitewings - four radiographic images |
751 |
736 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
519 |
503 |
$19K |
| D2330 |
|
238 |
124 |
$13K |
| D1354 |
|
909 |
207 |
$10K |
| D9420 |
|
377 |
376 |
$642.20 |
| D9986 |
|
31 |
16 |
$0.00 |
| D0603 |
|
57 |
55 |
$0.00 |