| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
28,202 |
27,025 |
$755K |
| D0120 |
Periodic oral evaluation - established patient |
33,217 |
31,832 |
$595K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,059 |
5,342 |
$595K |
| D1208 |
Topical application of fluoride, excluding varnish |
31,878 |
30,450 |
$438K |
| D1999 |
|
19,931 |
17,608 |
$358K |
| D1351 |
Sealant - per tooth |
14,956 |
4,700 |
$340K |
| D0272 |
Bitewings - two radiographic images |
18,148 |
17,381 |
$308K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,306 |
1,427 |
$291K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,586 |
11,515 |
$268K |
| D0330 |
Panoramic radiographic image |
5,659 |
5,338 |
$254K |
| D1110 |
Prophylaxis - adult |
6,362 |
6,050 |
$215K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,926 |
2,284 |
$192K |
| D1206 |
Topical application of fluoride varnish |
5,733 |
5,616 |
$125K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,672 |
857 |
$122K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,104 |
1,425 |
$118K |
| D0274 |
Bitewings - four radiographic images |
3,844 |
3,647 |
$85K |
| D0220 |
Intraoral - periapical first radiographic image |
6,858 |
6,494 |
$69K |
| D0140 |
Limited oral evaluation - problem focused |
2,194 |
2,067 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,807 |
2,961 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,099 |
2,015 |
$48K |
| D1354 |
|
1,777 |
640 |
$42K |
| D0240 |
|
1,383 |
774 |
$22K |
| D2332 |
|
164 |
96 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
524 |
515 |
$11K |
| D0251 |
|
417 |
414 |
$10K |
| D2330 |
|
61 |
38 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
25 |
$2K |
| D1510 |
|
15 |
12 |
$2K |