| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
37,514 |
37,174 |
$1.34M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19,126 |
9,760 |
$1.09M |
| D9248 |
|
5,884 |
5,223 |
$766K |
| D0120 |
Periodic oral evaluation - established patient |
32,878 |
32,585 |
$728K |
| D1208 |
Topical application of fluoride, excluding varnish |
37,864 |
37,527 |
$670K |
| D1351 |
Sealant - per tooth |
31,319 |
7,935 |
$666K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,717 |
3,057 |
$595K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,009 |
4,596 |
$404K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,731 |
4,471 |
$306K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,514 |
7,450 |
$259K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15,489 |
14,065 |
$229K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,492 |
2,072 |
$213K |
| D0272 |
Bitewings - two radiographic images |
14,885 |
14,718 |
$143K |
| D0240 |
|
6,625 |
6,366 |
$115K |
| D0330 |
Panoramic radiographic image |
3,276 |
3,239 |
$100K |
| D0140 |
Limited oral evaluation - problem focused |
2,643 |
2,585 |
$93K |
| D0603 |
|
6,382 |
6,317 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
9,862 |
9,706 |
$50K |
| D0274 |
Bitewings - four radiographic images |
4,223 |
4,196 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
821 |
674 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,817 |
7,694 |
$43K |
| D2332 |
|
708 |
434 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
739 |
726 |
$34K |
| D0602 |
|
3,876 |
3,827 |
$34K |
| D1110 |
Prophylaxis - adult |
1,045 |
1,030 |
$32K |
| D9420 |
|
95 |
88 |
$25K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,140 |
1,122 |
$20K |
| D0601 |
|
2,375 |
2,341 |
$19K |
| D1510 |
|
96 |
79 |
$12K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
12 |
$7K |
| D1206 |
Topical application of fluoride varnish |
686 |
669 |
$6K |
| D2390 |
|
58 |
25 |
$5K |
| D2330 |
|
104 |
66 |
$4K |
| D1354 |
|
375 |
108 |
$1K |
| D9920 |
|
59 |
56 |
$548.00 |
| D0270 |
|
100 |
98 |
$437.75 |
| D1999 |
|
3,059 |
3,009 |
$0.00 |