| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
23,197 |
22,694 |
$1.22M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,614 |
2,317 |
$1.10M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
19,661 |
19,179 |
$552K |
| D1208 |
Topical application of fluoride, excluding varnish |
24,303 |
23,774 |
$381K |
| D9248 |
|
3,368 |
3,127 |
$368K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,691 |
2,728 |
$319K |
| D0272 |
Bitewings - two radiographic images |
13,657 |
13,312 |
$255K |
| D0330 |
Panoramic radiographic image |
4,107 |
4,028 |
$202K |
| D0220 |
Intraoral - periapical first radiographic image |
16,906 |
16,474 |
$186K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,143 |
14,911 |
$185K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,066 |
3,755 |
$153K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,162 |
1,630 |
$147K |
| D0120 |
Periodic oral evaluation - established patient |
3,723 |
3,696 |
$100K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,834 |
1,302 |
$99K |
| D9420 |
|
1,377 |
1,340 |
$88K |
| D1351 |
Sealant - per tooth |
3,904 |
990 |
$81K |
| D1110 |
Prophylaxis - adult |
1,185 |
1,168 |
$65K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,065 |
2,019 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,258 |
1,228 |
$45K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
314 |
202 |
$21K |
| D2330 |
|
118 |
66 |
$6K |
| D0274 |
Bitewings - four radiographic images |
109 |
109 |
$4K |
| D1354 |
|
28 |
12 |
$406.00 |
| D9986 |
|
5,619 |
4,907 |
$0.00 |