| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,195 |
7,296 |
$184K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,538 |
1,557 |
$170K |
| D1351 |
Sealant - per tooth |
7,170 |
1,217 |
$147K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,013 |
8,942 |
$137K |
| D0120 |
Periodic oral evaluation - established patient |
8,765 |
7,809 |
$136K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,632 |
949 |
$110K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,398 |
163 |
$108K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,103 |
3,161 |
$97K |
| D1110 |
Prophylaxis - adult |
1,916 |
1,741 |
$66K |
| D7140 |
Extraction, erupted tooth or exposed root |
779 |
308 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,307 |
1,205 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,430 |
1,266 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
3,508 |
3,111 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,145 |
1,008 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,010 |
939 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
410 |
390 |
$16K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
165 |
51 |
$9K |
| D0272 |
Bitewings - two radiographic images |
566 |
528 |
$8K |
| D0330 |
Panoramic radiographic image |
181 |
174 |
$7K |
| D9420 |
|
199 |
147 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
13 |
$1K |