| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
24,755 |
24,314 |
$1.07M |
| D0120 |
Periodic oral evaluation - established patient |
28,684 |
28,193 |
$841K |
| D1351 |
Sealant - per tooth |
22,941 |
4,500 |
$778K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,797 |
3,656 |
$707K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,027 |
2,758 |
$542K |
| D9248 |
|
2,906 |
2,790 |
$534K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,639 |
21,275 |
$494K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,042 |
1,688 |
$470K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,559 |
2,812 |
$433K |
| D1110 |
Prophylaxis - adult |
6,134 |
6,036 |
$366K |
| D1206 |
Topical application of fluoride varnish |
9,592 |
9,401 |
$234K |
| D0272 |
Bitewings - two radiographic images |
11,511 |
11,315 |
$174K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,122 |
3,059 |
$160K |
| D0140 |
Limited oral evaluation - problem focused |
3,071 |
2,945 |
$134K |
| D3120 |
|
3,604 |
2,317 |
$125K |
| D0330 |
Panoramic radiographic image |
2,631 |
2,587 |
$112K |
| D1330 |
|
17,531 |
17,211 |
$107K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,051 |
4,905 |
$92K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,124 |
2,080 |
$86K |
| D0220 |
Intraoral - periapical first radiographic image |
4,682 |
4,569 |
$44K |
| D2330 |
|
450 |
292 |
$38K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
415 |
287 |
$24K |
| D0240 |
|
1,775 |
1,738 |
$16K |
| D2335 |
|
100 |
55 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,365 |
1,338 |
$15K |
| D1510 |
|
182 |
155 |
$15K |
| D0274 |
Bitewings - four radiographic images |
404 |
401 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
25 |
$4K |
| D9420 |
|
14 |
14 |
$210.00 |