| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
7,774 |
7,673 |
$971K |
| D1120 |
Prophylaxis - child |
19,854 |
19,783 |
$663K |
| D1351 |
Sealant - per tooth |
23,370 |
5,298 |
$649K |
| D1206 |
Topical application of fluoride varnish |
28,023 |
27,880 |
$557K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,970 |
1,592 |
$548K |
| D0120 |
Periodic oral evaluation - established patient |
19,264 |
19,194 |
$424K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,579 |
2,289 |
$235K |
| D1110 |
Prophylaxis - adult |
5,570 |
5,544 |
$223K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,166 |
3,940 |
$200K |
| D1330 |
|
15,423 |
15,378 |
$176K |
| D1310 |
|
15,444 |
15,399 |
$169K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,366 |
1,158 |
$165K |
| D0272 |
Bitewings - two radiographic images |
8,560 |
8,525 |
$155K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,559 |
1,796 |
$142K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,532 |
5,504 |
$129K |
| D0140 |
Limited oral evaluation - problem focused |
1,622 |
1,602 |
$67K |
| D0274 |
Bitewings - four radiographic images |
2,111 |
2,098 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
3,646 |
3,618 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,056 |
922 |
$24K |
| D1354 |
|
585 |
495 |
$21K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
221 |
144 |
$19K |
| D0330 |
Panoramic radiographic image |
395 |
392 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
438 |
438 |
$10K |
| D2332 |
|
23 |
12 |
$2K |
| D2330 |
|
23 |
13 |
$1K |
| D1999 |
|
66 |
63 |
$380.00 |
| D0603 |
|
68 |
68 |
$340.00 |