| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,668 |
11,303 |
$471K |
| D1206 |
Topical application of fluoride varnish |
11,533 |
11,172 |
$295K |
| D0120 |
Periodic oral evaluation - established patient |
10,274 |
9,955 |
$284K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,216 |
1,864 |
$127K |
| D1351 |
Sealant - per tooth |
1,543 |
1,093 |
$115K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,494 |
1,287 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
6,351 |
6,116 |
$38K |
| D0272 |
Bitewings - two radiographic images |
3,637 |
3,497 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,765 |
5,445 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,304 |
1,255 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,107 |
1,091 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
410 |
350 |
$18K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
239 |
216 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
530 |
450 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
119 |
111 |
$6K |
| D9310 |
|
330 |
317 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
305 |
295 |
$5K |
| D1354 |
|
123 |
90 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
195 |
188 |
$3K |
| D0330 |
Panoramic radiographic image |
143 |
140 |
$3K |
| D2330 |
|
45 |
43 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
15 |
15 |
$790.50 |
| D1208 |
Topical application of fluoride, excluding varnish |
17 |
17 |
$442.00 |