| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
28,347 |
26,723 |
$1.37M |
| D0120 |
Periodic oral evaluation - established patient |
32,301 |
30,387 |
$877K |
| D1206 |
Topical application of fluoride varnish |
34,041 |
32,048 |
$841K |
| D1351 |
Sealant - per tooth |
15,841 |
4,495 |
$589K |
| D1110 |
Prophylaxis - adult |
7,889 |
7,298 |
$468K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,441 |
2,659 |
$447K |
| D0272 |
Bitewings - two radiographic images |
11,317 |
10,842 |
$324K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,600 |
808 |
$289K |
| D0274 |
Bitewings - four radiographic images |
7,436 |
6,783 |
$281K |
| D7240 |
Removal of impacted tooth - completely bony |
773 |
220 |
$245K |
| D0140 |
Limited oral evaluation - problem focused |
5,273 |
4,879 |
$210K |
| D0330 |
Panoramic radiographic image |
3,214 |
2,852 |
$183K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,005 |
1,210 |
$175K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,845 |
1,275 |
$147K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,397 |
6,697 |
$141K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,714 |
2,520 |
$131K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,357 |
808 |
$123K |
| D0220 |
Intraoral - periapical first radiographic image |
4,486 |
4,053 |
$75K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
241 |
96 |
$31K |
| D1354 |
|
2,159 |
733 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
442 |
387 |
$28K |
| D7111 |
|
267 |
169 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
654 |
600 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
102 |
80 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
841 |
520 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
89 |
54 |
$9K |
| D7230 |
|
26 |
12 |
$6K |
| D2140 |
|
40 |
25 |
$2K |
| D2160 |
|
12 |
12 |
$1K |
| D0240 |
|
16 |
14 |
$208.00 |
| D1999 |
|
5,942 |
5,497 |
$0.00 |
| PERI0 |
|
47 |
45 |
$0.00 |
| D0603 |
|
4,118 |
4,022 |
$0.00 |
| D0602 |
|
294 |
290 |
$0.00 |