| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
36,695 |
35,938 |
$1.80M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,668 |
2,456 |
$966K |
| D7140 |
Extraction, erupted tooth or exposed root |
15,754 |
6,711 |
$759K |
| D0120 |
Periodic oral evaluation - established patient |
33,460 |
32,762 |
$733K |
| D1208 |
Topical application of fluoride, excluding varnish |
37,797 |
37,007 |
$552K |
| D2934 |
|
4,154 |
1,006 |
$467K |
| D1351 |
Sealant - per tooth |
27,846 |
7,745 |
$439K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,647 |
4,209 |
$404K |
| D9248 |
|
5,751 |
5,583 |
$381K |
| D0330 |
Panoramic radiographic image |
9,163 |
8,896 |
$367K |
| D0272 |
Bitewings - two radiographic images |
18,183 |
17,780 |
$323K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,667 |
7,429 |
$267K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,683 |
1,901 |
$231K |
| D1110 |
Prophylaxis - adult |
3,354 |
3,288 |
$166K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,564 |
4,483 |
$115K |
| D9420 |
|
1,476 |
1,406 |
$93K |
| D2330 |
|
1,553 |
986 |
$82K |
| D0140 |
Limited oral evaluation - problem focused |
2,533 |
2,408 |
$76K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,200 |
1,517 |
$45K |
| D3110 |
|
2,335 |
940 |
$37K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,382 |
1,336 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,523 |
1,494 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,612 |
1,536 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
98 |
78 |
$7K |
| D1354 |
|
1,079 |
434 |
$5K |
| D7111 |
|
16 |
15 |
$866.65 |
| D9986 |
|
8,525 |
7,691 |
$489.00 |
| D9987 |
|
2,386 |
2,033 |
$456.00 |
| D0603 |
|
140 |
128 |
$0.00 |
| D9995 |
|
17 |
17 |
$0.00 |
| D1999 |
|
6,671 |
6,382 |
$0.00 |