| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,366 |
14,080 |
$391K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,699 |
1,282 |
$387K |
| D0120 |
Periodic oral evaluation - established patient |
12,286 |
12,114 |
$323K |
| D1351 |
Sealant - per tooth |
10,835 |
2,732 |
$302K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,517 |
2,467 |
$283K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,620 |
2,065 |
$279K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,328 |
6,177 |
$278K |
| D1206 |
Topical application of fluoride varnish |
17,176 |
16,842 |
$275K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,729 |
2,122 |
$217K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,888 |
3,761 |
$163K |
| D0140 |
Limited oral evaluation - problem focused |
3,551 |
3,407 |
$131K |
| D0220 |
Intraoral - periapical first radiographic image |
7,414 |
7,214 |
$113K |
| D1110 |
Prophylaxis - adult |
2,915 |
2,865 |
$112K |
| D0272 |
Bitewings - two radiographic images |
6,191 |
6,051 |
$104K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,674 |
3,082 |
$92K |
| D0330 |
Panoramic radiographic image |
2,266 |
2,184 |
$83K |
| D0240 |
|
3,436 |
2,592 |
$55K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
655 |
416 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,561 |
1,516 |
$46K |
| D0145 |
Oral evaluation for a patient under three years of age |
927 |
908 |
$33K |
| D2330 |
|
279 |
183 |
$18K |
| D9420 |
|
80 |
80 |
$10K |
| D7111 |
|
133 |
97 |
$7K |
| D1515 |
|
17 |
15 |
$4K |
| D1517 |
|
13 |
13 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
105 |
104 |
$2K |
| D1354 |
|
179 |
85 |
$1K |