| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
36,666 |
36,085 |
$1.35M |
| D0120 |
Periodic oral evaluation - established patient |
39,685 |
39,053 |
$1.15M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,799 |
7,030 |
$964K |
| D1110 |
Prophylaxis - adult |
13,210 |
12,948 |
$683K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,300 |
5,800 |
$628K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,856 |
1,668 |
$610K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,733 |
13,210 |
$567K |
| D0330 |
Panoramic radiographic image |
9,629 |
9,382 |
$563K |
| D1206 |
Topical application of fluoride varnish |
20,145 |
19,868 |
$547K |
| D1208 |
Topical application of fluoride, excluding varnish |
25,939 |
25,427 |
$524K |
| D0272 |
Bitewings - two radiographic images |
21,626 |
21,236 |
$489K |
| D1351 |
Sealant - per tooth |
10,707 |
3,669 |
$327K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,075 |
4,995 |
$246K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,355 |
4,221 |
$219K |
| D0220 |
Intraoral - periapical first radiographic image |
13,408 |
12,879 |
$178K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,156 |
1,364 |
$173K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,836 |
6,092 |
$164K |
| D7240 |
Removal of impacted tooth - completely bony |
445 |
161 |
$110K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
797 |
663 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
5,874 |
5,674 |
$86K |
| D9920 |
|
1,163 |
1,014 |
$73K |
| D2390 |
|
154 |
52 |
$35K |
| D7111 |
|
219 |
154 |
$14K |
| D2330 |
|
150 |
76 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
237 |
237 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
125 |
81 |
$11K |
| D9420 |
|
63 |
54 |
$5K |
| D1510 |
|
83 |
50 |
$3K |
| D9248 |
|
13 |
13 |
$2K |
| D9986 |
|
151 |
146 |
$0.00 |