| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
61,854 |
61,250 |
$1.69M |
| D1206 |
Topical application of fluoride varnish |
72,686 |
71,949 |
$1.24M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,826 |
3,479 |
$1.08M |
| D0120 |
Periodic oral evaluation - established patient |
61,228 |
60,607 |
$990K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,310 |
5,476 |
$728K |
| D1351 |
Sealant - per tooth |
21,565 |
6,056 |
$597K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,889 |
4,503 |
$496K |
| D1110 |
Prophylaxis - adult |
11,638 |
11,496 |
$446K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,331 |
13,763 |
$405K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,270 |
12,148 |
$340K |
| D0272 |
Bitewings - two radiographic images |
18,756 |
18,577 |
$325K |
| D0230 |
Intraoral - periapical each additional radiographic image |
34,535 |
12,584 |
$290K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,002 |
2,105 |
$201K |
| D0220 |
Intraoral - periapical first radiographic image |
17,790 |
17,514 |
$152K |
| D0240 |
|
13,162 |
9,775 |
$132K |
| D0274 |
Bitewings - four radiographic images |
5,422 |
5,342 |
$118K |
| D0210 |
Intraoral - complete series of radiographic images |
2,865 |
2,758 |
$110K |
| D9630 |
|
7,439 |
7,359 |
$109K |
| D0140 |
Limited oral evaluation - problem focused |
5,083 |
4,995 |
$107K |
| D0330 |
Panoramic radiographic image |
2,180 |
2,148 |
$106K |
| D9310 |
|
214 |
214 |
$21K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
286 |
165 |
$17K |
| D9999 |
Unspecified adjunctive procedure, by report |
44 |
41 |
$7K |
| D3120 |
|
576 |
418 |
$7K |
| D1354 |
|
93 |
37 |
$1K |