| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
50,970 |
50,529 |
$1.63M |
| D0120 |
Periodic oral evaluation - established patient |
59,158 |
58,629 |
$1.37M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,284 |
7,847 |
$1.15M |
| D1206 |
Topical application of fluoride varnish |
55,065 |
54,591 |
$1.10M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,560 |
3,350 |
$1.06M |
| D9248 |
|
8,364 |
8,142 |
$706K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
8,347 |
3,158 |
$671K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,383 |
4,060 |
$501K |
| D1110 |
Prophylaxis - adult |
11,012 |
10,909 |
$453K |
| D0330 |
Panoramic radiographic image |
8,630 |
8,539 |
$348K |
| D0272 |
Bitewings - two radiographic images |
19,106 |
18,908 |
$316K |
| D0230 |
Intraoral - periapical each additional radiographic image |
36,901 |
11,485 |
$295K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,518 |
2,174 |
$205K |
| D0220 |
Intraoral - periapical first radiographic image |
16,180 |
15,941 |
$186K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,412 |
6,364 |
$182K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,510 |
5,327 |
$137K |
| D0274 |
Bitewings - four radiographic images |
5,167 |
5,118 |
$130K |
| D1351 |
Sealant - per tooth |
2,080 |
602 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
2,983 |
2,931 |
$65K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
748 |
503 |
$60K |
| D7962 |
|
322 |
298 |
$60K |
| D2331 |
|
546 |
298 |
$40K |
| D7961 |
|
202 |
180 |
$28K |
| D2933 |
|
123 |
40 |
$20K |
| D2330 |
|
50 |
27 |
$3K |
| D0431 |
|
539 |
536 |
$103.00 |
| D1999 |
|
119 |
116 |
$0.00 |