| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
25,049 |
24,581 |
$1.08M |
| D0120 |
Periodic oral evaluation - established patient |
24,971 |
24,513 |
$1.06M |
| D1206 |
Topical application of fluoride varnish |
27,384 |
26,842 |
$845K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,728 |
2,563 |
$378K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,024 |
1,697 |
$311K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,965 |
2,181 |
$268K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,180 |
1,258 |
$255K |
| D0274 |
Bitewings - four radiographic images |
9,894 |
9,713 |
$229K |
| D0210 |
Intraoral - complete series of radiographic images |
2,899 |
2,898 |
$214K |
| D0272 |
Bitewings - two radiographic images |
7,379 |
7,238 |
$198K |
| D1110 |
Prophylaxis - adult |
6,150 |
6,017 |
$177K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,314 |
9,480 |
$160K |
| D1351 |
Sealant - per tooth |
3,483 |
1,007 |
$148K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
840 |
401 |
$140K |
| D0220 |
Intraoral - periapical first radiographic image |
9,636 |
9,341 |
$125K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,373 |
2,314 |
$102K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,151 |
7,295 |
$89K |
| D0330 |
Panoramic radiographic image |
3,385 |
3,357 |
$75K |
| D0602 |
|
7,864 |
7,720 |
$56K |
| D0601 |
|
7,688 |
7,491 |
$56K |
| D0603 |
|
6,859 |
6,674 |
$51K |
| D0240 |
|
4,342 |
1,886 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
927 |
893 |
$39K |
| D9420 |
|
61 |
56 |
$19K |
| D0273 |
|
886 |
872 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
76 |
60 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
41 |
25 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
86 |
86 |
$2K |
| D1999 |
|
10,820 |
10,327 |
$0.00 |
| D1330 |
|
16,890 |
16,415 |
$0.00 |