| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
67,209 |
67,128 |
$3.06M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20,055 |
14,404 |
$2.03M |
| D0120 |
Periodic oral evaluation - established patient |
62,547 |
62,470 |
$1.92M |
| D1351 |
Sealant - per tooth |
20,802 |
9,329 |
$1.23M |
| D1206 |
Topical application of fluoride varnish |
28,859 |
28,811 |
$926K |
| D0272 |
Bitewings - two radiographic images |
41,530 |
41,488 |
$747K |
| D1208 |
Topical application of fluoride, excluding varnish |
47,379 |
47,318 |
$707K |
| D1110 |
Prophylaxis - adult |
10,495 |
10,475 |
$636K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,871 |
2,915 |
$513K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,088 |
6,665 |
$507K |
| D0220 |
Intraoral - periapical first radiographic image |
32,210 |
32,002 |
$473K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14,811 |
14,790 |
$458K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,800 |
5,907 |
$424K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,414 |
2,129 |
$282K |
| D0240 |
|
9,641 |
9,285 |
$233K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,706 |
24,678 |
$186K |
| D0274 |
Bitewings - four radiographic images |
5,396 |
5,394 |
$165K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,557 |
1,242 |
$133K |
| D0210 |
Intraoral - complete series of radiographic images |
4,252 |
4,222 |
$51K |
| D9990 |
|
2,256 |
2,071 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
3,566 |
3,532 |
$49K |
| D0330 |
Panoramic radiographic image |
1,170 |
1,166 |
$49K |
| D0145 |
Oral evaluation for a patient under three years of age |
464 |
464 |
$14K |
| D9310 |
|
104 |
104 |
$8K |
| D0270 |
|
135 |
135 |
$2K |
| D2330 |
|
20 |
14 |
$1K |
| D9430 |
|
60 |
60 |
$1K |
| D1354 |
|
61 |
27 |
$915.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
281 |
252 |
$0.00 |