| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,867 |
9,717 |
$322K |
| D1206 |
Topical application of fluoride varnish |
10,950 |
10,787 |
$226K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,053 |
1,940 |
$224K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,637 |
1,117 |
$179K |
| D0120 |
Periodic oral evaluation - established patient |
7,348 |
7,236 |
$177K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,672 |
6,940 |
$142K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,818 |
3,551 |
$109K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,655 |
3,600 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
8,200 |
8,000 |
$98K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,522 |
1,077 |
$91K |
| D1351 |
Sealant - per tooth |
3,084 |
1,006 |
$91K |
| D9248 |
|
1,034 |
997 |
$83K |
| D1110 |
Prophylaxis - adult |
2,011 |
1,982 |
$83K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,115 |
735 |
$69K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
721 |
567 |
$58K |
| D0272 |
Bitewings - two radiographic images |
3,071 |
3,021 |
$52K |
| D0274 |
Bitewings - four radiographic images |
2,066 |
2,030 |
$51K |
| D0330 |
Panoramic radiographic image |
1,062 |
1,043 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
782 |
769 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
769 |
759 |
$18K |
| D1354 |
|
809 |
241 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
341 |
338 |
$7K |
| D2332 |
|
46 |
37 |
$4K |
| D2331 |
|
20 |
13 |
$2K |
| D2330 |
|
15 |
12 |
$999.30 |
| D1330 |
|
141 |
140 |
$0.00 |
| D9310 |
|
27 |
27 |
$0.00 |