| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
29,179 |
29,038 |
$1.30M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
8,733 |
5,000 |
$933K |
| D0120 |
Periodic oral evaluation - established patient |
21,102 |
21,012 |
$717K |
| D1206 |
Topical application of fluoride varnish |
22,938 |
22,844 |
$643K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,830 |
7,792 |
$494K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,342 |
2,253 |
$370K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,381 |
1,084 |
$272K |
| D0272 |
Bitewings - two radiographic images |
6,702 |
6,681 |
$208K |
| D0140 |
Limited oral evaluation - problem focused |
3,876 |
3,838 |
$180K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,377 |
1,082 |
$178K |
| D2160 |
|
1,250 |
1,026 |
$171K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,922 |
2,525 |
$168K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,758 |
5,709 |
$161K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,427 |
942 |
$154K |
| D0274 |
Bitewings - four radiographic images |
3,215 |
3,202 |
$150K |
| D1351 |
Sealant - per tooth |
3,093 |
832 |
$120K |
| D2140 |
|
1,230 |
904 |
$110K |
| D0220 |
Intraoral - periapical first radiographic image |
5,423 |
5,359 |
$100K |
| D0330 |
Panoramic radiographic image |
1,096 |
1,088 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
509 |
387 |
$46K |
| D7111 |
|
311 |
247 |
$27K |
| D2335 |
|
118 |
74 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,164 |
869 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
15 |
$3K |
| D9310 |
|
21 |
21 |
$699.72 |