| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
27,818 |
27,742 |
$1.14M |
| D0120 |
Periodic oral evaluation - established patient |
19,159 |
19,117 |
$1.13M |
| D1310 |
|
14,527 |
14,461 |
$660K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,291 |
4,613 |
$541K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,206 |
6,197 |
$408K |
| D9993 |
|
6,111 |
6,098 |
$389K |
| D1206 |
Topical application of fluoride varnish |
18,255 |
18,196 |
$358K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,050 |
7,500 |
$318K |
| D1351 |
Sealant - per tooth |
9,802 |
3,195 |
$290K |
| D0230 |
Intraoral - periapical each additional radiographic image |
62,933 |
22,115 |
$250K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,364 |
3,357 |
$217K |
| D0272 |
Bitewings - two radiographic images |
16,192 |
16,163 |
$187K |
| D0603 |
|
10,649 |
10,613 |
$158K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,300 |
874 |
$152K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,696 |
1,832 |
$143K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,556 |
1,661 |
$143K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,112 |
9,099 |
$114K |
| D9430 |
|
2,841 |
2,764 |
$88K |
| D0220 |
Intraoral - periapical first radiographic image |
6,935 |
6,718 |
$81K |
| D0350 |
|
6,598 |
4,059 |
$65K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
762 |
625 |
$59K |
| D0602 |
|
2,929 |
2,919 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,677 |
1,675 |
$35K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
187 |
121 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
248 |
248 |
$11K |
| D2330 |
|
32 |
24 |
$2K |
| D0601 |
|
153 |
152 |
$2K |
| D1354 |
|
74 |
50 |
$1K |
| D9610 |
|
16 |
13 |
$1K |
| D9995 |
|
548 |
536 |
$743.52 |