| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
61,835 |
58,264 |
$2.55M |
| D0120 |
Periodic oral evaluation - established patient |
54,300 |
51,114 |
$1.71M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,630 |
10,727 |
$1.67M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14,944 |
9,534 |
$1.19M |
| D1206 |
Topical application of fluoride varnish |
33,797 |
30,758 |
$835K |
| D1208 |
Topical application of fluoride, excluding varnish |
27,266 |
26,693 |
$744K |
| D0272 |
Bitewings - two radiographic images |
14,462 |
13,428 |
$411K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,517 |
6,131 |
$376K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,240 |
6,256 |
$375K |
| D1351 |
Sealant - per tooth |
8,743 |
3,192 |
$302K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,116 |
1,650 |
$297K |
| D0140 |
Limited oral evaluation - problem focused |
7,065 |
6,215 |
$288K |
| D0274 |
Bitewings - four radiographic images |
6,742 |
6,265 |
$287K |
| D0330 |
Panoramic radiographic image |
2,923 |
2,769 |
$218K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,387 |
341 |
$199K |
| D9243 |
|
778 |
331 |
$120K |
| D7240 |
Removal of impacted tooth - completely bony |
309 |
86 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
5,104 |
3,342 |
$64K |
| D9420 |
|
655 |
473 |
$43K |
| D9310 |
|
1,412 |
1,238 |
$39K |
| D9239 |
|
383 |
308 |
$37K |
| D7230 |
|
133 |
49 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
216 |
168 |
$24K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
249 |
82 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
974 |
395 |
$11K |
| D1110 |
Prophylaxis - adult |
121 |
96 |
$66.56 |