| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
60,527 |
58,436 |
$1.65M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,514 |
3,868 |
$1.55M |
| D0120 |
Periodic oral evaluation - established patient |
55,500 |
53,810 |
$1.43M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,578 |
8,273 |
$1.21M |
| D1206 |
Topical application of fluoride varnish |
69,426 |
67,009 |
$1.11M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19,423 |
18,493 |
$853K |
| D1351 |
Sealant - per tooth |
26,543 |
7,049 |
$740K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,740 |
6,543 |
$690K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,614 |
4,087 |
$489K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,164 |
10,631 |
$485K |
| D0272 |
Bitewings - two radiographic images |
23,981 |
23,136 |
$440K |
| D0330 |
Panoramic radiographic image |
6,993 |
6,735 |
$395K |
| D1110 |
Prophylaxis - adult |
8,663 |
8,429 |
$335K |
| D0140 |
Limited oral evaluation - problem focused |
6,675 |
6,386 |
$245K |
| D0220 |
Intraoral - periapical first radiographic image |
13,175 |
12,478 |
$192K |
| D0240 |
|
9,561 |
4,752 |
$149K |
| D0274 |
Bitewings - four radiographic images |
4,112 |
3,998 |
$131K |
| D2390 |
|
742 |
275 |
$125K |
| D9420 |
|
762 |
729 |
$89K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,208 |
2,041 |
$76K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,442 |
2,882 |
$74K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
562 |
338 |
$45K |
| D1354 |
|
3,486 |
1,277 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
134 |
120 |
$17K |
| D2330 |
|
72 |
50 |
$5K |
| D7111 |
|
70 |
41 |
$4K |
| D9986 |
|
12,893 |
12,435 |
$0.00 |
| D1999 |
|
12,986 |
12,588 |
$0.00 |
| D9987 |
|
3,540 |
3,468 |
$0.00 |
| D1330 |
|
7,872 |
7,735 |
$0.00 |
| D1310 |
|
7,893 |
7,759 |
$0.00 |
| D0171 |
|
39 |
39 |
$0.00 |