| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
39,181 |
39,023 |
$1.64M |
| D0120 |
Periodic oral evaluation - established patient |
24,898 |
24,819 |
$1.48M |
| D1310 |
|
15,618 |
15,541 |
$710K |
| D1206 |
Topical application of fluoride varnish |
38,834 |
38,678 |
$638K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,422 |
5,207 |
$627K |
| D0230 |
Intraoral - periapical each additional radiographic image |
140,432 |
32,987 |
$581K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,258 |
7,217 |
$473K |
| D1351 |
Sealant - per tooth |
13,884 |
3,767 |
$435K |
| D0220 |
Intraoral - periapical first radiographic image |
35,599 |
35,160 |
$422K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,485 |
9,288 |
$372K |
| D9993 |
|
5,608 |
5,600 |
$360K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,796 |
1,608 |
$321K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,367 |
3,236 |
$305K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,240 |
3,226 |
$202K |
| D0603 |
|
11,872 |
11,816 |
$176K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,517 |
1,759 |
$135K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,247 |
852 |
$122K |
| D0350 |
|
5,187 |
3,083 |
$51K |
| D9430 |
|
1,543 |
1,479 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
391 |
302 |
$31K |
| D0601 |
|
2,069 |
2,064 |
$31K |
| D1510 |
|
62 |
51 |
$9K |
| D0602 |
|
555 |
553 |
$8K |
| D2330 |
|
99 |
75 |
$7K |
| D1354 |
|
205 |
87 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
128 |
128 |
$1K |
| D2332 |
|
14 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
52 |
52 |
$624.00 |
| D0274 |
Bitewings - four radiographic images |
21 |
21 |
$453.60 |