| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
41,626 |
41,026 |
$2.35M |
| D0120 |
Periodic oral evaluation - established patient |
40,490 |
39,895 |
$1.01M |
| D7140 |
Extraction, erupted tooth or exposed root |
12,223 |
5,371 |
$795K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,041 |
1,609 |
$663K |
| D0330 |
Panoramic radiographic image |
9,917 |
9,738 |
$580K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,007 |
5,546 |
$477K |
| D0272 |
Bitewings - two radiographic images |
21,633 |
21,299 |
$437K |
| D1208 |
Topical application of fluoride, excluding varnish |
26,403 |
26,116 |
$429K |
| D1351 |
Sealant - per tooth |
20,158 |
6,064 |
$381K |
| D1206 |
Topical application of fluoride varnish |
18,333 |
17,929 |
$327K |
| D1110 |
Prophylaxis - adult |
4,821 |
4,709 |
$267K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,792 |
6,626 |
$231K |
| D2934 |
|
2,200 |
476 |
$230K |
| D9248 |
|
3,640 |
3,490 |
$229K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,075 |
6,937 |
$206K |
| D0140 |
Limited oral evaluation - problem focused |
2,305 |
2,219 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,115 |
966 |
$74K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
953 |
391 |
$56K |
| D9420 |
|
727 |
680 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,159 |
1,026 |
$33K |
| D2330 |
|
556 |
366 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,378 |
2,302 |
$26K |
| D0145 |
Oral evaluation for a patient under three years of age |
773 |
768 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
392 |
376 |
$18K |
| D7111 |
|
229 |
179 |
$13K |
| D3110 |
|
516 |
229 |
$8K |
| D9986 |
|
5,470 |
5,352 |
$6K |
| D1354 |
|
39 |
14 |
$309.50 |
| D1999 |
|
2,581 |
2,445 |
$0.00 |