| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
35,373 |
34,848 |
$782K |
| D1208 |
Topical application of fluoride, excluding varnish |
37,552 |
36,966 |
$624K |
| D0120 |
Periodic oral evaluation - established patient |
32,754 |
32,208 |
$620K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,146 |
1,544 |
$566K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,701 |
5,427 |
$559K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,498 |
2,865 |
$342K |
| D1351 |
Sealant - per tooth |
12,315 |
3,934 |
$312K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,494 |
3,700 |
$299K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,862 |
5,767 |
$167K |
| D0272 |
Bitewings - two radiographic images |
14,554 |
14,358 |
$163K |
| D0330 |
Panoramic radiographic image |
2,862 |
2,787 |
$149K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,956 |
839 |
$135K |
| D1110 |
Prophylaxis - adult |
2,750 |
2,678 |
$102K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,365 |
956 |
$92K |
| D0140 |
Limited oral evaluation - problem focused |
3,527 |
3,434 |
$79K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
584 |
363 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
4,175 |
4,098 |
$23K |
| D1354 |
|
976 |
501 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
847 |
822 |
$22K |
| D2140 |
|
413 |
285 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,162 |
1,546 |
$12K |
| D0274 |
Bitewings - four radiographic images |
463 |
451 |
$10K |
| D2335 |
|
87 |
48 |
$8K |
| D2160 |
|
129 |
83 |
$8K |
| D2330 |
|
110 |
76 |
$6K |
| D2332 |
|
54 |
39 |
$3K |
| D0240 |
|
185 |
105 |
$2K |
| D2331 |
|
17 |
12 |
$1K |
| D9420 |
|
33 |
28 |
$0.00 |