| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
13,933 |
13,933 |
$703K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,324 |
4,101 |
$652K |
| D1120 |
Prophylaxis - child |
18,597 |
18,597 |
$650K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,469 |
4,767 |
$609K |
| D0120 |
Periodic oral evaluation - established patient |
22,704 |
22,704 |
$526K |
| D1206 |
Topical application of fluoride varnish |
32,187 |
32,187 |
$526K |
| D0274 |
Bitewings - four radiographic images |
14,220 |
14,220 |
$380K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,545 |
10,990 |
$376K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,009 |
8,009 |
$330K |
| D0330 |
Panoramic radiographic image |
5,986 |
5,986 |
$294K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,184 |
1,297 |
$281K |
| D0272 |
Bitewings - two radiographic images |
12,978 |
12,978 |
$241K |
| D1351 |
Sealant - per tooth |
7,321 |
2,559 |
$221K |
| D0220 |
Intraoral - periapical first radiographic image |
7,955 |
7,908 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
1,942 |
1,931 |
$73K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
554 |
441 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,353 |
5,664 |
$69K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,589 |
1,589 |
$65K |
| D7111 |
|
759 |
496 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
386 |
249 |
$40K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
432 |
296 |
$33K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
188 |
114 |
$16K |
| D9310 |
|
135 |
134 |
$8K |
| D2160 |
|
29 |
24 |
$3K |