| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
28,436 |
28,422 |
$1.50M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,535 |
2,426 |
$804K |
| D1110 |
Prophylaxis - adult |
9,238 |
9,233 |
$714K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,083 |
4,967 |
$632K |
| D0330 |
Panoramic radiographic image |
6,665 |
6,660 |
$480K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,006 |
6,005 |
$288K |
| D0210 |
Intraoral - complete series of radiographic images |
2,193 |
2,193 |
$279K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,271 |
3,381 |
$223K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,012 |
4,012 |
$199K |
| D1351 |
Sealant - per tooth |
17,518 |
2,778 |
$157K |
| D0140 |
Limited oral evaluation - problem focused |
4,571 |
4,522 |
$144K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,412 |
1,639 |
$109K |
| D9420 |
|
1,361 |
1,358 |
$62K |
| D8660 |
|
508 |
508 |
$35K |
| D1206 |
Topical application of fluoride varnish |
39,725 |
39,704 |
$25K |
| D0272 |
Bitewings - two radiographic images |
22,173 |
22,160 |
$14K |
| D1510 |
|
16 |
14 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
31,131 |
31,114 |
$5K |
| D2332 |
|
38 |
24 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$3K |
| D0274 |
Bitewings - four radiographic images |
6,020 |
6,018 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,372 |
826 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,728 |
8,915 |
$1K |
| D8670 |
Periodic orthodontic treatment visit |
13 |
13 |
$1K |
| D0240 |
|
5,645 |
2,876 |
$696.69 |
| D0220 |
Intraoral - periapical first radiographic image |
12,498 |
12,273 |
$370.05 |
| D1208 |
Topical application of fluoride, excluding varnish |
550 |
549 |
$100.30 |
| D2330 |
|
18 |
13 |
$68.07 |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,497 |
4,165 |
$61.42 |