| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
20,464 |
20,232 |
$1.29M |
| D0120 |
Periodic oral evaluation - established patient |
30,105 |
29,872 |
$1.27M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,018 |
6,324 |
$969K |
| D1206 |
Topical application of fluoride varnish |
28,762 |
28,503 |
$953K |
| D0274 |
Bitewings - four radiographic images |
16,934 |
16,767 |
$826K |
| D0330 |
Panoramic radiographic image |
7,945 |
7,802 |
$774K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,330 |
5,594 |
$679K |
| D1120 |
Prophylaxis - child |
14,889 |
14,786 |
$674K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,385 |
1,395 |
$334K |
| D0140 |
Limited oral evaluation - problem focused |
7,094 |
6,870 |
$317K |
| D0220 |
Intraoral - periapical first radiographic image |
14,948 |
14,330 |
$268K |
| D1351 |
Sealant - per tooth |
6,620 |
1,873 |
$264K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,389 |
9,323 |
$247K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,852 |
1,606 |
$215K |
| D2331 |
|
1,875 |
1,226 |
$215K |
| D1354 |
|
4,714 |
1,183 |
$211K |
| D1330 |
|
5,536 |
5,473 |
$188K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
755 |
225 |
$147K |
| D0272 |
Bitewings - two radiographic images |
3,647 |
3,617 |
$145K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,413 |
2,357 |
$144K |
| D2330 |
|
799 |
515 |
$62K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
485 |
341 |
$43K |
| D1310 |
|
1,195 |
1,186 |
$40K |
| D2332 |
|
193 |
132 |
$23K |
| D2394 |
|
186 |
169 |
$19K |
| D7111 |
|
98 |
54 |
$14K |
| D2335 |
|
200 |
163 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
467 |
439 |
$11K |
| D2160 |
|
89 |
82 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
243 |
243 |
$11K |
| D9410 |
|
269 |
267 |
$6K |
| D2140 |
|
110 |
77 |
$5K |
| D9920 |
|
68 |
67 |
$5K |
| D0240 |
|
97 |
56 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
14 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
30 |
14 |
$4K |
| D4355 |
|
70 |
66 |
$3K |
| 98960 |
|
158 |
150 |
$3K |
| D9110 |
|
12 |
12 |
$565.24 |
| D9420 |
|
12 |
12 |
$534.22 |
| D0383 |
|
13 |
13 |
$0.00 |