| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
24,356 |
22,934 |
$1.15M |
| D1120 |
Prophylaxis - child |
21,366 |
20,224 |
$1.07M |
| D0120 |
Periodic oral evaluation - established patient |
17,417 |
16,658 |
$508K |
| D1351 |
Sealant - per tooth |
17,793 |
3,378 |
$358K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,523 |
790 |
$203K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,831 |
2,270 |
$193K |
| D0274 |
Bitewings - four radiographic images |
6,547 |
6,164 |
$133K |
| D0140 |
Limited oral evaluation - problem focused |
4,286 |
3,859 |
$124K |
| D1110 |
Prophylaxis - adult |
2,661 |
2,571 |
$116K |
| D0272 |
Bitewings - two radiographic images |
6,216 |
5,770 |
$112K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,134 |
5,668 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,095 |
2,818 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,104 |
1,299 |
$79K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,673 |
964 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
5,052 |
4,287 |
$61K |
| D0330 |
Panoramic radiographic image |
1,827 |
1,742 |
$59K |
| D1354 |
|
4,185 |
1,392 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,049 |
3,107 |
$20K |
| D0190 |
|
1,036 |
994 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
445 |
435 |
$8K |
| D9215 |
|
673 |
587 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
281 |
266 |
$2K |
| D1510 |
|
24 |
13 |
$2K |
| D9310 |
|
28 |
28 |
$2K |
| D1353 |
|
95 |
29 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
17 |
13 |
$904.12 |
| D9420 |
|
12 |
12 |
$450.89 |
| D0160 |
|
14 |
13 |
$405.79 |
| D0350 |
|
19 |
17 |
$0.00 |
| D1330 |
|
593 |
588 |
$0.00 |
| D0240 |
|
23 |
13 |
$0.00 |