| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
27,963 |
27,293 |
$1.01M |
| D0120 |
Periodic oral evaluation - established patient |
27,774 |
27,136 |
$791K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,933 |
2,003 |
$705K |
| D1208 |
Topical application of fluoride, excluding varnish |
31,586 |
30,865 |
$652K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,757 |
3,727 |
$601K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,702 |
2,301 |
$336K |
| D0272 |
Bitewings - two radiographic images |
12,532 |
12,270 |
$279K |
| D1110 |
Prophylaxis - adult |
5,141 |
5,037 |
$267K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,216 |
6,498 |
$266K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,616 |
1,046 |
$167K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,274 |
3,203 |
$161K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,599 |
706 |
$142K |
| D0330 |
Panoramic radiographic image |
2,050 |
2,012 |
$119K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,334 |
910 |
$98K |
| D1351 |
Sealant - per tooth |
2,620 |
724 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,662 |
1,567 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
5,990 |
4,929 |
$69K |
| D9420 |
|
600 |
556 |
$52K |
| D2934 |
|
114 |
33 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,233 |
1,704 |
$30K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
413 |
177 |
$30K |
| D2330 |
|
303 |
120 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
1,351 |
1,304 |
$19K |
| D2332 |
|
42 |
24 |
$6K |
| D1206 |
Topical application of fluoride varnish |
178 |
178 |
$6K |
| D2932 |
|
36 |
12 |
$5K |
| D2140 |
|
17 |
14 |
$1K |
| D9920 |
|
17 |
12 |
$911.30 |