| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
18,494 |
18,240 |
$803K |
| D0120 |
Periodic oral evaluation - established patient |
21,032 |
20,749 |
$621K |
| D1206 |
Topical application of fluoride varnish |
20,150 |
19,875 |
$499K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,628 |
1,805 |
$318K |
| D1110 |
Prophylaxis - adult |
4,147 |
4,094 |
$251K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,616 |
865 |
$247K |
| D1351 |
Sealant - per tooth |
4,942 |
1,506 |
$170K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,535 |
905 |
$167K |
| D0272 |
Bitewings - two radiographic images |
6,028 |
5,956 |
$92K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
953 |
760 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,653 |
1,630 |
$87K |
| D3120 |
|
2,442 |
1,787 |
$84K |
| D0274 |
Bitewings - four radiographic images |
3,545 |
3,487 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,671 |
2,630 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,333 |
1,300 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,107 |
2,974 |
$56K |
| D0330 |
Panoramic radiographic image |
1,120 |
1,109 |
$50K |
| D0240 |
|
965 |
952 |
$16K |
| D9248 |
|
64 |
63 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,218 |
1,195 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
188 |
141 |
$11K |