| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
36,302 |
36,289 |
$2.75M |
| D1110 |
Prophylaxis - adult |
13,627 |
13,623 |
$1.51M |
| D0210 |
Intraoral - complete series of radiographic images |
4,666 |
4,666 |
$920K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,443 |
4,970 |
$783K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,340 |
7,337 |
$528K |
| D9420 |
|
1,679 |
1,678 |
$498K |
| D0274 |
Bitewings - four radiographic images |
15,413 |
15,406 |
$455K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,939 |
3,040 |
$226K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,598 |
3,598 |
$218K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,660 |
1,961 |
$132K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,416 |
1,138 |
$105K |
| D2934 |
|
343 |
118 |
$78K |
| D0330 |
Panoramic radiographic image |
4,873 |
4,868 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
1,918 |
1,907 |
$70K |
| D1351 |
Sealant - per tooth |
69,112 |
15,514 |
$41K |
| D4346 |
|
213 |
213 |
$33K |
| D2332 |
|
201 |
132 |
$16K |
| D7111 |
|
234 |
155 |
$9K |
| D1206 |
Topical application of fluoride varnish |
48,636 |
48,619 |
$6K |
| D9248 |
|
126 |
123 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
48,078 |
47,799 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
38,692 |
38,676 |
$4K |
| D1354 |
|
676 |
349 |
$3K |
| D0272 |
Bitewings - two radiographic images |
19,828 |
19,811 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
111,503 |
45,388 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,835 |
10,066 |
$1K |
| D2330 |
|
30 |
24 |
$610.75 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
454 |
229 |
$465.92 |
| D9310 |
|
13 |
12 |
$393.36 |