| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,019 |
6,585 |
$325K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,739 |
988 |
$193K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,621 |
1,661 |
$167K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,790 |
4,500 |
$120K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,397 |
3,465 |
$94K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,253 |
930 |
$93K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,727 |
903 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,407 |
5,917 |
$88K |
| D2332 |
|
1,071 |
581 |
$80K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,183 |
1,956 |
$77K |
| D1351 |
Sealant - per tooth |
3,617 |
1,417 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
3,172 |
2,952 |
$62K |
| D1110 |
Prophylaxis - adult |
1,029 |
943 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
4,261 |
3,958 |
$43K |
| D2335 |
|
383 |
194 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,424 |
1,417 |
$26K |
| D0272 |
Bitewings - two radiographic images |
681 |
638 |
$12K |
| D0274 |
Bitewings - four radiographic images |
384 |
362 |
$11K |
| D0330 |
Panoramic radiographic image |
106 |
104 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
129 |
118 |
$4K |
| D2331 |
|
37 |
27 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
32 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
26 |
14 |
$2K |