| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
32,445 |
31,273 |
$1.36M |
| D1206 |
Topical application of fluoride varnish |
33,044 |
31,867 |
$1.14M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,762 |
5,300 |
$937K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,984 |
3,069 |
$508K |
| D0120 |
Periodic oral evaluation - established patient |
24,490 |
23,692 |
$502K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,585 |
2,316 |
$482K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,396 |
2,823 |
$338K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,949 |
10,051 |
$328K |
| D1351 |
Sealant - per tooth |
9,892 |
3,832 |
$326K |
| D0272 |
Bitewings - two radiographic images |
10,846 |
10,483 |
$260K |
| D0220 |
Intraoral - periapical first radiographic image |
13,570 |
13,128 |
$203K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,120 |
10,809 |
$151K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,994 |
3,769 |
$140K |
| D0330 |
Panoramic radiographic image |
2,060 |
1,965 |
$124K |
| D0274 |
Bitewings - four radiographic images |
3,329 |
3,231 |
$113K |
| D9920 |
|
4,466 |
4,243 |
$112K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
344 |
278 |
$95K |
| D1310 |
|
2,153 |
1,747 |
$73K |
| D7111 |
|
1,305 |
771 |
$70K |
| D1330 |
|
2,322 |
1,888 |
$70K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,215 |
2,132 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,954 |
1,863 |
$64K |
| D3120 |
|
1,273 |
870 |
$48K |
| D9992 |
|
2,038 |
1,964 |
$45K |
| D1110 |
Prophylaxis - adult |
522 |
522 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
207 |
191 |
$30K |
| D1510 |
|
119 |
93 |
$24K |
| D2330 |
|
62 |
44 |
$4K |