| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
28,936 |
28,825 |
$1.31M |
| D0120 |
Periodic oral evaluation - established patient |
17,292 |
17,220 |
$1.18M |
| D1310 |
|
16,141 |
16,088 |
$734K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,874 |
7,848 |
$536K |
| D1206 |
Topical application of fluoride varnish |
27,412 |
27,296 |
$464K |
| D0230 |
Intraoral - periapical each additional radiographic image |
93,350 |
25,893 |
$379K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,248 |
3,240 |
$349K |
| D1351 |
Sealant - per tooth |
10,507 |
2,922 |
$320K |
| D9993 |
|
4,911 |
4,910 |
$314K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,245 |
7,095 |
$289K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,982 |
3,972 |
$267K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,654 |
1,210 |
$197K |
| D0220 |
Intraoral - periapical first radiographic image |
15,146 |
14,953 |
$180K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,327 |
2,173 |
$179K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,115 |
1,956 |
$177K |
| D0603 |
|
9,846 |
9,817 |
$146K |
| D0274 |
Bitewings - four radiographic images |
4,888 |
4,869 |
$104K |
| D2330 |
|
1,073 |
592 |
$81K |
| D0272 |
Bitewings - two radiographic images |
6,665 |
6,628 |
$76K |
| D0602 |
|
4,891 |
4,873 |
$73K |
| D0350 |
|
6,567 |
3,732 |
$67K |
| D9430 |
|
1,340 |
1,313 |
$43K |
| D3240 |
|
314 |
265 |
$31K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
308 |
213 |
$30K |
| D0330 |
Panoramic radiographic image |
966 |
960 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
299 |
274 |
$23K |
| D1510 |
|
205 |
180 |
$23K |
| D0601 |
|
775 |
775 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
732 |
732 |
$6K |
| D1354 |
|
357 |
114 |
$4K |
| D2390 |
|
26 |
12 |
$3K |
| D2332 |
|
18 |
15 |
$1K |
| D2331 |
|
21 |
17 |
$1K |
| D0270 |
|
46 |
46 |
$230.00 |
| D3120 |
|
247 |
207 |
$0.00 |