| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
29,685 |
29,648 |
$1.12M |
| D0120 |
Periodic oral evaluation - established patient |
32,480 |
32,463 |
$838K |
| D1351 |
Sealant - per tooth |
13,343 |
5,198 |
$612K |
| D1206 |
Topical application of fluoride varnish |
15,000 |
14,973 |
$403K |
| D1110 |
Prophylaxis - adult |
6,447 |
6,447 |
$332K |
| D0272 |
Bitewings - two radiographic images |
19,916 |
19,907 |
$298K |
| D9999 |
Unspecified adjunctive procedure, by report |
2,829 |
2,829 |
$279K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,359 |
3,009 |
$274K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,379 |
21,376 |
$268K |
| D0274 |
Bitewings - four radiographic images |
9,477 |
9,475 |
$245K |
| D0220 |
Intraoral - periapical first radiographic image |
10,771 |
10,741 |
$134K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
982 |
763 |
$101K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,751 |
1,337 |
$82K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,417 |
1,135 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,007 |
2,994 |
$76K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,615 |
7,613 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
886 |
885 |
$11K |
| D1354 |
|
587 |
203 |
$10K |
| D0601 |
|
5,033 |
5,033 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
58 |
51 |
$4K |
| D0602 |
|
2,191 |
2,191 |
$2K |
| D9310 |
|
17 |
17 |
$1K |
| D1999 |
|
21 |
21 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
28 |
28 |
$730.50 |
| D9995 |
|
13 |
13 |
$262.56 |
| D0603 |
|
227 |
227 |
$224.00 |
| D0350 |
|
17 |
17 |
$111.40 |