| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,131 |
7,925 |
$398K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,178 |
979 |
$253K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,819 |
1,636 |
$195K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,005 |
5,853 |
$161K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,354 |
1,513 |
$130K |
| D0272 |
Bitewings - two radiographic images |
6,496 |
6,360 |
$124K |
| D0330 |
Panoramic radiographic image |
2,349 |
2,287 |
$112K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,201 |
3,004 |
$110K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,965 |
1,098 |
$108K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,245 |
7,005 |
$104K |
| D1351 |
Sealant - per tooth |
4,137 |
1,288 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
3,990 |
3,890 |
$83K |
| D1110 |
Prophylaxis - adult |
1,626 |
1,590 |
$81K |
| D9248 |
|
794 |
776 |
$76K |
| D1206 |
Topical application of fluoride varnish |
2,468 |
2,463 |
$46K |
| D2332 |
|
479 |
327 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,711 |
2,613 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,030 |
1,000 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
589 |
564 |
$19K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
195 |
119 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,516 |
937 |
$11K |
| D2330 |
|
100 |
76 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$1K |