| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
69,857 |
68,332 |
$1.50M |
| D0120 |
Periodic oral evaluation - established patient |
57,438 |
56,488 |
$1.34M |
| D1120 |
Prophylaxis - child |
43,081 |
42,350 |
$1.32M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,011 |
10,556 |
$1.26M |
| D1110 |
Prophylaxis - adult |
19,511 |
19,208 |
$807K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,129 |
4,759 |
$621K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,344 |
1,822 |
$617K |
| D1351 |
Sealant - per tooth |
16,199 |
4,422 |
$512K |
| D0274 |
Bitewings - four radiographic images |
16,026 |
15,759 |
$493K |
| D0272 |
Bitewings - two radiographic images |
24,893 |
24,363 |
$472K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,868 |
5,010 |
$411K |
| D0330 |
Panoramic radiographic image |
7,548 |
7,424 |
$343K |
| D1330 |
|
44,644 |
43,929 |
$331K |
| D1310 |
|
44,637 |
43,923 |
$331K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,045 |
1,126 |
$234K |
| D0603 |
|
19,978 |
19,541 |
$194K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,815 |
5,723 |
$148K |
| D0240 |
|
6,009 |
4,025 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
2,272 |
2,204 |
$99K |
| D0220 |
Intraoral - periapical first radiographic image |
10,485 |
10,104 |
$97K |
| D2933 |
|
581 |
189 |
$96K |
| D3230 |
|
491 |
187 |
$88K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,024 |
819 |
$83K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,809 |
4,057 |
$51K |
| D1510 |
|
222 |
144 |
$32K |
| D0602 |
|
2,639 |
2,574 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
464 |
463 |
$25K |
| D2330 |
|
269 |
155 |
$15K |
| D2331 |
|
157 |
104 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
178 |
172 |
$8K |
| D9920 |
|
67 |
67 |
$4K |
| D2332 |
|
42 |
27 |
$3K |