| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
51,189 |
51,189 |
$1.66M |
| D1206 |
Topical application of fluoride varnish |
42,418 |
42,418 |
$1.01M |
| D0120 |
Periodic oral evaluation - established patient |
44,717 |
44,717 |
$985K |
| D1351 |
Sealant - per tooth |
14,275 |
5,288 |
$761K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,481 |
5,957 |
$575K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,208 |
4,849 |
$432K |
| D0272 |
Bitewings - two radiographic images |
28,761 |
28,761 |
$374K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,781 |
3,382 |
$366K |
| D1110 |
Prophylaxis - adult |
7,857 |
7,857 |
$336K |
| D2394 |
|
2,994 |
2,600 |
$336K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,773 |
3,377 |
$272K |
| D0274 |
Bitewings - four radiographic images |
10,195 |
10,195 |
$229K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,960 |
9,960 |
$229K |
| D0330 |
Panoramic radiographic image |
7,603 |
7,603 |
$222K |
| D0220 |
Intraoral - periapical first radiographic image |
21,445 |
21,385 |
$219K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,422 |
16,422 |
$188K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,286 |
4,286 |
$105K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,282 |
16,282 |
$86K |
| D9310 |
|
1,273 |
1,273 |
$78K |
| D0210 |
Intraoral - complete series of radiographic images |
1,743 |
1,742 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
772 |
686 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,302 |
3,075 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
2,807 |
2,797 |
$30K |
| D2335 |
|
43 |
40 |
$5K |
| D1354 |
|
118 |
42 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
39 |
$2K |
| D9110 |
|
85 |
85 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24 |
13 |
$2K |