| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,536 |
13,075 |
$529K |
| D0120 |
Periodic oral evaluation - established patient |
12,894 |
12,464 |
$350K |
| D1206 |
Topical application of fluoride varnish |
8,971 |
8,635 |
$228K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,824 |
2,337 |
$193K |
| D1351 |
Sealant - per tooth |
3,170 |
1,831 |
$159K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,781 |
3,657 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,579 |
1,370 |
$64K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
674 |
597 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,927 |
1,700 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,357 |
2,281 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
991 |
853 |
$50K |
| D0274 |
Bitewings - four radiographic images |
2,147 |
2,101 |
$39K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
607 |
546 |
$35K |
| D1110 |
Prophylaxis - adult |
732 |
731 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
5,415 |
5,204 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,267 |
4,021 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,627 |
1,580 |
$28K |
| D0272 |
Bitewings - two radiographic images |
2,601 |
2,511 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
234 |
214 |
$19K |
| D4341 |
|
97 |
49 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
367 |
363 |
$12K |
| D9310 |
|
556 |
522 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
37 |
33 |
$2K |
| D0270 |
|
73 |
73 |
$408.80 |
| D0330 |
Panoramic radiographic image |
20 |
20 |
$293.80 |
| D0601 |
|
2,030 |
1,959 |
$0.04 |
| D1999 |
|
1,627 |
1,349 |
$0.00 |
| D0603 |
|
243 |
239 |
$0.00 |
| D0602 |
|
974 |
949 |
$0.00 |