| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
93,975 |
11,594 |
$1.57M |
| D1120 |
Prophylaxis - child |
25,279 |
25,274 |
$775K |
| D1351 |
Sealant - per tooth |
14,716 |
5,658 |
$762K |
| D0120 |
Periodic oral evaluation - established patient |
31,772 |
31,768 |
$668K |
| D0274 |
Bitewings - four radiographic images |
24,817 |
24,817 |
$508K |
| D1110 |
Prophylaxis - adult |
9,840 |
9,839 |
$386K |
| D0220 |
Intraoral - periapical first radiographic image |
30,533 |
30,476 |
$325K |
| D1206 |
Topical application of fluoride varnish |
12,900 |
12,895 |
$301K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,857 |
2,690 |
$254K |
| D9990 |
|
10,334 |
9,936 |
$227K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,809 |
3,480 |
$226K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,662 |
19,659 |
$217K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,296 |
1,229 |
$211K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,316 |
1,719 |
$169K |
| D9996 |
|
13,429 |
13,146 |
$169K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,464 |
30,432 |
$161K |
| D2394 |
|
1,829 |
1,203 |
$155K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,255 |
1,137 |
$153K |
| D2335 |
|
847 |
482 |
$109K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,369 |
1,469 |
$105K |
| D0240 |
|
3,473 |
3,473 |
$83K |
| D2332 |
|
813 |
552 |
$58K |
| D0272 |
Bitewings - two radiographic images |
3,804 |
3,804 |
$47K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,790 |
1,788 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
4,039 |
3,800 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,244 |
1,131 |
$37K |
| D1510 |
|
405 |
330 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,274 |
1,274 |
$27K |
| D9420 |
|
484 |
367 |
$24K |
| D2330 |
|
478 |
294 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
1,630 |
1,628 |
$20K |
| D9995 |
|
604 |
577 |
$14K |
| D9991 |
|
1,304 |
1,304 |
$13K |
| D9920 |
|
1,109 |
1,056 |
$10K |
| D0330 |
Panoramic radiographic image |
63 |
63 |
$2K |
| D2331 |
|
33 |
27 |
$1K |
| D0273 |
|
51 |
51 |
$768.42 |
| D0340 |
|
12 |
12 |
$403.15 |