| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
27,682 |
27,464 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,855 |
4,792 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,117 |
23,001 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
27,027 |
26,779 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
34,436 |
34,118 |
$23K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,258 |
1,333 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,556 |
3,005 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,682 |
6,637 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
26,057 |
25,543 |
$12K |
| D0274 |
Bitewings - four radiographic images |
9,505 |
9,366 |
$9K |
| D1110 |
Prophylaxis - adult |
6,063 |
5,982 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,047 |
1,284 |
$7K |
| D0330 |
Panoramic radiographic image |
5,777 |
5,729 |
$6K |
| D0272 |
Bitewings - two radiographic images |
7,548 |
7,461 |
$5K |
| D1351 |
Sealant - per tooth |
6,776 |
2,227 |
$5K |
| D9248 |
|
2,120 |
2,074 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
3,404 |
3,303 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,905 |
2,807 |
$3K |
| D1354 |
|
3,257 |
833 |
$2K |
| D2330 |
|
266 |
106 |
$623.43 |
| D2335 |
|
99 |
42 |
$507.96 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
241 |
152 |
$505.48 |
| D2332 |
|
29 |
12 |
$103.90 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
46 |
36 |
$82.30 |
| D7111 |
|
31 |
26 |
$46.18 |
| D3120 |
|
99 |
64 |
$14.86 |
| D0145 |
Oral evaluation for a patient under three years of age |
79 |
77 |
$0.00 |
| D0340 |
|
80 |
80 |
$0.00 |
| D0190 |
|
13 |
13 |
$0.00 |
| D0601 |
|
43 |
43 |
$0.00 |
| D0603 |
|
16 |
16 |
$0.00 |
| D1310 |
|
15 |
15 |
$0.00 |