| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
45,588 |
45,585 |
$1.69M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
15,224 |
4,872 |
$1.63M |
| D0120 |
Periodic oral evaluation - established patient |
38,999 |
38,998 |
$1.38M |
| D1351 |
Sealant - per tooth |
21,006 |
5,982 |
$880K |
| D0274 |
Bitewings - four radiographic images |
16,047 |
16,047 |
$820K |
| D1206 |
Topical application of fluoride varnish |
42,771 |
42,767 |
$810K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,100 |
5,249 |
$729K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,680 |
10,047 |
$603K |
| D0220 |
Intraoral - periapical first radiographic image |
33,856 |
33,660 |
$570K |
| D0230 |
Intraoral - periapical each additional radiographic image |
34,781 |
30,066 |
$508K |
| D0272 |
Bitewings - two radiographic images |
15,390 |
15,390 |
$392K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,966 |
9,966 |
$371K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,718 |
2,901 |
$332K |
| D1110 |
Prophylaxis - adult |
6,033 |
6,033 |
$315K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,305 |
2,529 |
$297K |
| D0140 |
Limited oral evaluation - problem focused |
5,355 |
5,315 |
$196K |
| D0330 |
Panoramic radiographic image |
2,596 |
2,595 |
$195K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,147 |
714 |
$186K |
| D7230 |
|
395 |
293 |
$117K |
| D9310 |
|
1,480 |
1,478 |
$98K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
720 |
374 |
$60K |
| D1354 |
|
5,843 |
1,542 |
$51K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,313 |
1,299 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,383 |
5,383 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
653 |
653 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
272 |
189 |
$35K |
| D1510 |
|
112 |
81 |
$29K |
| D2335 |
|
68 |
38 |
$10K |
| D7240 |
Removal of impacted tooth - completely bony |
28 |
12 |
$9K |
| D0240 |
|
300 |
257 |
$6K |
| D2332 |
|
30 |
15 |
$5K |
| D2330 |
|
39 |
24 |
$3K |
| D0270 |
|
40 |
40 |
$442.37 |
| D1999 |
|
17 |
17 |
$0.00 |