| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
33,919 |
33,894 |
$1.09M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17,234 |
17,223 |
$609K |
| D1208 |
Topical application of fluoride, excluding varnish |
31,527 |
31,500 |
$577K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,484 |
4,274 |
$547K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,184 |
1,153 |
$386K |
| D0120 |
Periodic oral evaluation - established patient |
16,347 |
16,335 |
$374K |
| D0272 |
Bitewings - two radiographic images |
13,641 |
13,627 |
$282K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,997 |
3,017 |
$275K |
| D0274 |
Bitewings - four radiographic images |
8,548 |
8,541 |
$255K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,267 |
7,761 |
$225K |
| D0220 |
Intraoral - periapical first radiographic image |
17,984 |
17,916 |
$207K |
| D1351 |
Sealant - per tooth |
7,313 |
2,245 |
$176K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,228 |
17,093 |
$159K |
| D0210 |
Intraoral - complete series of radiographic images |
3,115 |
2,748 |
$154K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,678 |
1,054 |
$111K |
| D8660 |
|
780 |
778 |
$82K |
| D0240 |
|
6,096 |
4,238 |
$82K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
794 |
568 |
$72K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
671 |
194 |
$55K |
| D0330 |
Panoramic radiographic image |
1,324 |
1,322 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
1,728 |
1,695 |
$52K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
12 |
12 |
$47K |
| D1206 |
Topical application of fluoride varnish |
1,652 |
1,652 |
$30K |
| D2929 |
|
210 |
67 |
$26K |
| D9420 |
|
295 |
290 |
$23K |
| D1110 |
Prophylaxis - adult |
234 |
234 |
$8K |
| D7111 |
|
113 |
89 |
$5K |
| D0270 |
|
38 |
38 |
$414.00 |