| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
71,422 |
71,422 |
$2.43M |
| D0120 |
Periodic oral evaluation - established patient |
75,105 |
75,105 |
$1.72M |
| D1351 |
Sealant - per tooth |
31,943 |
17,481 |
$1.67M |
| D7140 |
Extraction, erupted tooth or exposed root |
20,403 |
18,008 |
$988K |
| D1206 |
Topical application of fluoride varnish |
30,458 |
30,457 |
$735K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,820 |
6,636 |
$694K |
| D0272 |
Bitewings - two radiographic images |
51,095 |
51,094 |
$672K |
| D1208 |
Topical application of fluoride, excluding varnish |
52,950 |
52,950 |
$594K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,432 |
4,156 |
$561K |
| D1110 |
Prophylaxis - adult |
11,639 |
11,639 |
$533K |
| D0274 |
Bitewings - four radiographic images |
20,719 |
20,719 |
$463K |
| D0220 |
Intraoral - periapical first radiographic image |
38,024 |
37,694 |
$416K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,719 |
2,844 |
$275K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,001 |
8,001 |
$188K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,227 |
2,739 |
$144K |
| D1354 |
|
7,528 |
2,115 |
$141K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,554 |
21,539 |
$121K |
| D0140 |
Limited oral evaluation - problem focused |
6,244 |
6,193 |
$71K |
| D2332 |
|
745 |
626 |
$63K |
| D7111 |
|
437 |
427 |
$16K |
| D2335 |
|
99 |
65 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
73 |
68 |
$6K |
| D9995 |
|
178 |
164 |
$4K |
| D9420 |
|
85 |
85 |
$4K |
| D9310 |
|
50 |
50 |
$2K |
| D0350 |
|
163 |
155 |
$2K |
| D1510 |
|
12 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
24 |
24 |
$576.00 |