| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,050 |
10,009 |
$496K |
| D0120 |
Periodic oral evaluation - established patient |
5,478 |
5,458 |
$355K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,680 |
1,065 |
$314K |
| D1310 |
|
6,151 |
6,126 |
$273K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,485 |
1,720 |
$228K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,100 |
3,092 |
$205K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,490 |
9,446 |
$205K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,177 |
1,476 |
$179K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,693 |
715 |
$164K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,078 |
3,827 |
$162K |
| D1351 |
Sealant - per tooth |
3,928 |
1,482 |
$144K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,475 |
1,419 |
$132K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,899 |
8,192 |
$127K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,299 |
1,294 |
$88K |
| D0603 |
|
5,013 |
4,993 |
$73K |
| D0272 |
Bitewings - two radiographic images |
5,448 |
5,427 |
$63K |
| D0350 |
|
4,275 |
2,268 |
$43K |
| D1510 |
|
140 |
109 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,685 |
1,645 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
426 |
426 |
$15K |
| D0330 |
Panoramic radiographic image |
450 |
450 |
$13K |
| D0274 |
Bitewings - four radiographic images |
611 |
611 |
$13K |
| D9430 |
|
400 |
381 |
$12K |
| D0340 |
|
233 |
233 |
$12K |
| D9993 |
|
180 |
180 |
$11K |
| D1206 |
Topical application of fluoride varnish |
500 |
499 |
$11K |
| D0602 |
|
728 |
724 |
$11K |
| D2330 |
|
86 |
54 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
18 |
$2K |
| D0270 |
|
30 |
30 |
$145.00 |