| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
24,594 |
23,549 |
$983K |
| D1351 |
Sealant - per tooth |
12,147 |
5,661 |
$738K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,348 |
3,954 |
$721K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,470 |
22,492 |
$593K |
| D0120 |
Periodic oral evaluation - established patient |
21,379 |
20,525 |
$580K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,318 |
4,733 |
$312K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,052 |
3,578 |
$311K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,105 |
2,774 |
$281K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,043 |
10,367 |
$229K |
| D2140 |
|
4,097 |
3,201 |
$162K |
| D0274 |
Bitewings - four radiographic images |
9,444 |
8,915 |
$157K |
| D4341 |
|
791 |
450 |
$138K |
| D0272 |
Bitewings - two radiographic images |
12,831 |
12,247 |
$122K |
| D9110 |
|
2,245 |
2,102 |
$119K |
| D0220 |
Intraoral - periapical first radiographic image |
20,510 |
19,250 |
$117K |
| D1110 |
Prophylaxis - adult |
2,900 |
2,716 |
$95K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,772 |
14,095 |
$73K |
| D2740 |
Crown - porcelain/ceramic |
239 |
204 |
$59K |
| D2160 |
|
742 |
603 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
565 |
464 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
2,102 |
1,990 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
324 |
230 |
$19K |
| D2330 |
|
447 |
372 |
$19K |
| D2331 |
|
191 |
160 |
$12K |
| D9310 |
|
746 |
715 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
452 |
423 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
170 |
146 |
$6K |
| D2950 |
|
79 |
73 |
$4K |
| D2332 |
|
44 |
36 |
$3K |
| D1206 |
Topical application of fluoride varnish |
88 |
85 |
$2K |
| D2920 |
|
93 |
85 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
64 |
55 |
$2K |
| D2335 |
|
17 |
16 |
$1K |