| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
15,623 |
15,514 |
$743K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,128 |
5,631 |
$725K |
| D0120 |
Periodic oral evaluation - established patient |
9,637 |
9,561 |
$691K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,364 |
3,675 |
$494K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,778 |
4,754 |
$321K |
| D0230 |
Intraoral - periapical each additional radiographic image |
74,320 |
13,984 |
$302K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,775 |
2,478 |
$292K |
| D1206 |
Topical application of fluoride varnish |
15,521 |
15,415 |
$279K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,331 |
1,488 |
$273K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,315 |
5,324 |
$251K |
| D1310 |
|
5,399 |
5,349 |
$230K |
| D1351 |
Sealant - per tooth |
6,781 |
2,210 |
$227K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,049 |
2,020 |
$169K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,618 |
1,052 |
$158K |
| D0350 |
|
14,730 |
6,309 |
$147K |
| D9430 |
|
3,358 |
3,036 |
$107K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,375 |
1,365 |
$97K |
| D0272 |
Bitewings - two radiographic images |
7,648 |
7,589 |
$90K |
| D0274 |
Bitewings - four radiographic images |
3,634 |
3,615 |
$77K |
| D2330 |
|
681 |
439 |
$52K |
| D9993 |
|
762 |
759 |
$44K |
| D0603 |
|
2,620 |
2,589 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
907 |
907 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
610 |
608 |
$28K |
| D0330 |
Panoramic radiographic image |
888 |
888 |
$26K |
| D1510 |
|
140 |
132 |
$26K |
| D0601 |
|
1,557 |
1,547 |
$23K |
| D8670 |
Periodic orthodontic treatment visit |
70 |
70 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,531 |
1,491 |
$18K |
| D2932 |
|
171 |
85 |
$17K |
| D2394 |
|
185 |
151 |
$15K |
| D0602 |
|
920 |
912 |
$14K |