| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
27,077 |
26,454 |
$762K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,306 |
2,219 |
$626K |
| D0120 |
Periodic oral evaluation - established patient |
20,366 |
19,956 |
$442K |
| D1206 |
Topical application of fluoride varnish |
27,867 |
27,229 |
$351K |
| D1351 |
Sealant - per tooth |
14,787 |
4,525 |
$258K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,635 |
2,001 |
$200K |
| D0272 |
Bitewings - two radiographic images |
13,688 |
13,429 |
$191K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,596 |
6,469 |
$180K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,356 |
2,121 |
$176K |
| D0240 |
|
11,446 |
6,101 |
$129K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,290 |
1,579 |
$100K |
| D0603 |
|
16,773 |
16,264 |
$88K |
| D1110 |
Prophylaxis - adult |
2,021 |
1,980 |
$87K |
| D0140 |
Limited oral evaluation - problem focused |
3,737 |
3,548 |
$86K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,757 |
4,552 |
$83K |
| D1354 |
|
12,046 |
3,972 |
$80K |
| D9420 |
|
496 |
466 |
$65K |
| D0330 |
Panoramic radiographic image |
1,782 |
1,729 |
$53K |
| D8660 |
|
362 |
335 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
5,902 |
5,561 |
$45K |
| D2929 |
|
491 |
123 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,556 |
3,019 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,239 |
1,208 |
$29K |
| D9920 |
|
5,975 |
5,819 |
$21K |
| D0601 |
|
5,810 |
5,680 |
$21K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
237 |
98 |
$15K |
| D1510 |
|
66 |
55 |
$6K |
| D0602 |
|
1,288 |
1,269 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
756 |
745 |
$2K |
| D0270 |
|
156 |
151 |
$2K |
| D1999 |
|
1,783 |
1,720 |
$1K |
| D7111 |
|
13 |
12 |
$516.00 |
| D1320 |
|
1,757 |
1,723 |
$60.00 |
| D1310 |
|
27,538 |
26,972 |
$40.00 |
| D1330 |
|
27,539 |
26,975 |
$40.00 |
| D0470 |
|
361 |
334 |
$0.00 |
| D3120 |
|
564 |
324 |
$0.00 |
| D9995 |
|
19 |
18 |
$0.00 |
| D9986 |
|
414 |
401 |
$0.00 |
| D9971 |
|
37 |
12 |
$0.00 |