| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
58,624 |
58,618 |
$1.89M |
| D0120 |
Periodic oral evaluation - established patient |
67,279 |
67,271 |
$1.46M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,674 |
4,068 |
$1.04M |
| D1351 |
Sealant - per tooth |
19,181 |
7,809 |
$897K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,619 |
6,140 |
$650K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,473 |
2,372 |
$648K |
| D1208 |
Topical application of fluoride, excluding varnish |
54,191 |
54,184 |
$613K |
| D1110 |
Prophylaxis - adult |
12,605 |
12,603 |
$515K |
| D2335 |
|
3,398 |
1,353 |
$443K |
| D0272 |
Bitewings - two radiographic images |
36,171 |
36,165 |
$438K |
| D0330 |
Panoramic radiographic image |
15,063 |
15,060 |
$424K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,751 |
4,313 |
$323K |
| D1206 |
Topical application of fluoride varnish |
14,256 |
14,256 |
$311K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,167 |
3,608 |
$213K |
| D0220 |
Intraoral - periapical first radiographic image |
15,093 |
15,091 |
$137K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,103 |
12,098 |
$86K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
999 |
855 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,924 |
2,924 |
$63K |
| D2330 |
|
619 |
443 |
$41K |
| D7111 |
|
1,344 |
1,110 |
$34K |
| D0145 |
Oral evaluation for a patient under three years of age |
913 |
913 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
1,499 |
1,485 |
$17K |
| D0274 |
Bitewings - four radiographic images |
600 |
600 |
$12K |
| D2332 |
|
142 |
100 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
193 |
193 |
$4K |
| D0251 |
|
254 |
253 |
$3K |
| D9995 |
|
122 |
118 |
$3K |
| D1999 |
|
16,079 |
16,078 |
$2K |
| D9110 |
|
143 |
142 |
$2K |
| D9996 |
|
87 |
86 |
$866.64 |
| D1330 |
|
10,727 |
10,727 |
$0.00 |
| D0603 |
|
65 |
65 |
$0.00 |
| D1310 |
|
1,978 |
1,978 |
$0.00 |