| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
41,820 |
41,014 |
$1.42M |
| D0120 |
Periodic oral evaluation - established patient |
44,177 |
43,628 |
$1.05M |
| D1110 |
Prophylaxis - adult |
20,782 |
20,396 |
$948K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,765 |
4,475 |
$894K |
| D1206 |
Topical application of fluoride varnish |
37,916 |
37,219 |
$762K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,192 |
4,800 |
$743K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19,477 |
18,559 |
$612K |
| D0220 |
Intraoral - periapical first radiographic image |
45,780 |
45,092 |
$570K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,567 |
2,726 |
$570K |
| D0230 |
Intraoral - periapical each additional radiographic image |
42,459 |
41,787 |
$556K |
| D0210 |
Intraoral - complete series of radiographic images |
6,852 |
6,756 |
$544K |
| D0272 |
Bitewings - two radiographic images |
22,159 |
21,872 |
$463K |
| D1351 |
Sealant - per tooth |
12,040 |
3,447 |
$416K |
| D0274 |
Bitewings - four radiographic images |
12,139 |
11,966 |
$358K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,332 |
2,164 |
$330K |
| D1208 |
Topical application of fluoride, excluding varnish |
24,389 |
23,912 |
$290K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,465 |
1,665 |
$259K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,652 |
4,600 |
$186K |
| D2140 |
|
1,254 |
921 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
2,631 |
2,579 |
$92K |
| D2160 |
|
727 |
487 |
$89K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,363 |
2,339 |
$75K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
354 |
285 |
$55K |
| D3120 |
|
1,074 |
774 |
$39K |
| D7111 |
|
615 |
419 |
$30K |
| D0350 |
|
525 |
428 |
$22K |
| D1353 |
|
440 |
135 |
$15K |
| D0330 |
Panoramic radiographic image |
97 |
97 |
$5K |
| D0603 |
|
232 |
212 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
13 |
12 |
$1K |