| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
24,127 |
23,878 |
$830K |
| D1206 |
Topical application of fluoride varnish |
37,976 |
37,584 |
$814K |
| D0120 |
Periodic oral evaluation - established patient |
35,205 |
34,852 |
$728K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,048 |
4,157 |
$639K |
| D1110 |
Prophylaxis - adult |
12,893 |
12,762 |
$623K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,573 |
1,957 |
$492K |
| D1351 |
Sealant - per tooth |
13,920 |
3,944 |
$453K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,063 |
3,577 |
$380K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,506 |
8,295 |
$297K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,446 |
1,935 |
$286K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,981 |
2,346 |
$266K |
| D9248 |
|
1,972 |
1,943 |
$224K |
| D0274 |
Bitewings - four radiographic images |
7,738 |
7,654 |
$219K |
| D0210 |
Intraoral - complete series of radiographic images |
4,622 |
4,204 |
$196K |
| D0272 |
Bitewings - two radiographic images |
9,409 |
9,320 |
$195K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,392 |
3,345 |
$108K |
| D0330 |
Panoramic radiographic image |
1,565 |
1,543 |
$87K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
585 |
440 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
1,560 |
1,535 |
$40K |
| D2940 |
|
947 |
477 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
1,610 |
1,590 |
$18K |
| D9630 |
|
808 |
800 |
$17K |
| D2331 |
|
102 |
67 |
$11K |
| D0270 |
|
872 |
864 |
$10K |
| D3120 |
|
489 |
397 |
$9K |
| D0240 |
|
228 |
209 |
$3K |
| D2330 |
|
17 |
12 |
$1K |