| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
45,463 |
44,107 |
$1.73M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,211 |
4,775 |
$1.66M |
| D1351 |
Sealant - per tooth |
44,522 |
10,787 |
$1.48M |
| D0120 |
Periodic oral evaluation - established patient |
56,099 |
54,383 |
$1.45M |
| D1206 |
Topical application of fluoride varnish |
57,435 |
55,610 |
$1.34M |
| D7140 |
Extraction, erupted tooth or exposed root |
12,478 |
6,813 |
$1.09M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,867 |
8,264 |
$969K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16,748 |
15,751 |
$937K |
| D1110 |
Prophylaxis - adult |
18,744 |
18,257 |
$850K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,312 |
7,891 |
$686K |
| D0272 |
Bitewings - two radiographic images |
32,799 |
31,804 |
$605K |
| D0274 |
Bitewings - four radiographic images |
12,071 |
11,721 |
$378K |
| D9248 |
|
1,325 |
1,257 |
$302K |
| D1330 |
|
35,710 |
35,586 |
$244K |
| D0240 |
|
13,355 |
8,120 |
$226K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,138 |
1,691 |
$216K |
| D0330 |
Panoramic radiographic image |
5,317 |
5,201 |
$210K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,763 |
6,618 |
$175K |
| D0603 |
|
19,705 |
19,623 |
$167K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,306 |
7,091 |
$165K |
| D0220 |
Intraoral - periapical first radiographic image |
11,911 |
11,462 |
$119K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,185 |
668 |
$111K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,408 |
6,322 |
$72K |
| D0140 |
Limited oral evaluation - problem focused |
3,203 |
3,136 |
$60K |
| D2332 |
|
659 |
396 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
508 |
433 |
$42K |
| D2933 |
|
206 |
67 |
$37K |
| D2330 |
|
461 |
289 |
$30K |
| D1510 |
|
201 |
150 |
$29K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,221 |
1,199 |
$28K |
| D0602 |
|
3,255 |
3,244 |
$26K |
| D3230 |
|
121 |
46 |
$22K |
| D2140 |
|
300 |
232 |
$17K |
| D2335 |
|
176 |
137 |
$14K |
| D2331 |
|
142 |
112 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
165 |
165 |
$9K |
| D1517 |
|
28 |
27 |
$7K |
| D9110 |
|
178 |
169 |
$6K |
| D0601 |
|
526 |
525 |
$5K |
| D1354 |
|
105 |
41 |
$1K |
| D0270 |
|
51 |
50 |
$489.24 |
| D1999 |
|
138 |
133 |
$0.15 |
| D0170 |
|
12 |
12 |
$0.00 |