| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
34,930 |
34,358 |
$1.83M |
| D0120 |
Periodic oral evaluation - established patient |
30,036 |
29,542 |
$698K |
| D1208 |
Topical application of fluoride, excluding varnish |
40,248 |
39,554 |
$629K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,005 |
5,485 |
$557K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,602 |
2,288 |
$540K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,122 |
2,874 |
$361K |
| D0330 |
Panoramic radiographic image |
7,215 |
7,075 |
$337K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,574 |
2,574 |
$319K |
| D0272 |
Bitewings - two radiographic images |
14,842 |
14,541 |
$283K |
| D1110 |
Prophylaxis - adult |
5,257 |
5,136 |
$282K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,967 |
7,809 |
$229K |
| D1351 |
Sealant - per tooth |
10,728 |
3,358 |
$219K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,738 |
1,573 |
$182K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,644 |
4,524 |
$150K |
| D0220 |
Intraoral - periapical first radiographic image |
7,715 |
7,490 |
$85K |
| D2330 |
|
1,532 |
903 |
$84K |
| D7111 |
|
1,349 |
1,002 |
$67K |
| D9420 |
|
1,215 |
1,206 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,965 |
3,773 |
$56K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,994 |
1,967 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,136 |
1,110 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,319 |
1,297 |
$38K |
| D1515 |
|
38 |
30 |
$9K |
| D2332 |
|
78 |
50 |
$6K |
| D9110 |
|
184 |
180 |
$5K |
| D1517 |
|
12 |
12 |
$3K |
| D1999 |
|
146 |
140 |
$0.00 |