| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
32,299 |
31,710 |
$1.67M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,519 |
3,815 |
$861K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
25,195 |
24,648 |
$677K |
| D1206 |
Topical application of fluoride varnish |
35,363 |
34,685 |
$544K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
7,093 |
3,655 |
$439K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,282 |
4,067 |
$423K |
| D0330 |
Panoramic radiographic image |
8,229 |
8,091 |
$384K |
| D0272 |
Bitewings - two radiographic images |
18,832 |
18,452 |
$343K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,112 |
3,160 |
$341K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,874 |
3,059 |
$314K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,966 |
7,554 |
$292K |
| D0120 |
Periodic oral evaluation - established patient |
10,414 |
10,284 |
$271K |
| D1351 |
Sealant - per tooth |
11,753 |
3,454 |
$246K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,917 |
2,902 |
$212K |
| D2330 |
|
3,418 |
2,072 |
$181K |
| D0220 |
Intraoral - periapical first radiographic image |
16,778 |
16,382 |
$179K |
| D1110 |
Prophylaxis - adult |
2,964 |
2,880 |
$146K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,433 |
14,535 |
$124K |
| D2932 |
|
1,046 |
453 |
$110K |
| D2140 |
|
2,199 |
1,352 |
$104K |
| D2331 |
|
621 |
392 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
328 |
270 |
$27K |
| D1510 |
|
168 |
148 |
$23K |
| D9420 |
|
760 |
745 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
72 |
72 |
$2K |
| D2931 |
|
20 |
12 |
$2K |
| D9110 |
|
54 |
52 |
$1K |
| D9986 |
|
802 |
560 |
$0.00 |