| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
48,556 |
46,135 |
$1.47M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,117 |
3,548 |
$1.43M |
| D1206 |
Topical application of fluoride varnish |
63,949 |
60,742 |
$1.22M |
| D1351 |
Sealant - per tooth |
49,094 |
9,187 |
$1.16M |
| D0120 |
Periodic oral evaluation - established patient |
55,805 |
53,094 |
$1.12M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,230 |
7,212 |
$934K |
| D1110 |
Prophylaxis - adult |
18,390 |
17,497 |
$754K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,865 |
4,553 |
$607K |
| D0272 |
Bitewings - two radiographic images |
23,965 |
22,690 |
$498K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,367 |
5,305 |
$422K |
| D2390 |
|
3,083 |
1,130 |
$350K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,837 |
11,687 |
$337K |
| D0330 |
Panoramic radiographic image |
6,791 |
6,411 |
$295K |
| D0274 |
Bitewings - four radiographic images |
9,438 |
8,958 |
$274K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,185 |
6,833 |
$231K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,282 |
1,164 |
$204K |
| D1510 |
|
1,883 |
1,012 |
$197K |
| D0210 |
Intraoral - complete series of radiographic images |
4,905 |
4,317 |
$170K |
| D0240 |
|
10,554 |
4,683 |
$147K |
| D2330 |
|
2,001 |
1,268 |
$120K |
| D0140 |
Limited oral evaluation - problem focused |
3,890 |
3,643 |
$116K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,522 |
3,322 |
$93K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,500 |
1,052 |
$91K |
| D2332 |
|
823 |
522 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
5,815 |
5,378 |
$57K |
| D1354 |
|
387 |
137 |
$32K |
| D9248 |
|
1,590 |
1,423 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,397 |
917 |
$10K |
| D1556 |
|
91 |
53 |
$2K |