| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
37,685 |
37,673 |
$2.07M |
| D0120 |
Periodic oral evaluation - established patient |
44,863 |
44,850 |
$1.69M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,336 |
4,104 |
$1.16M |
| D1208 |
Topical application of fluoride, excluding varnish |
29,969 |
29,965 |
$1.11M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,058 |
1,549 |
$845K |
| D1110 |
Prophylaxis - adult |
10,851 |
10,850 |
$627K |
| D1206 |
Topical application of fluoride varnish |
16,568 |
16,558 |
$603K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,830 |
1,965 |
$406K |
| D0272 |
Bitewings - two radiographic images |
13,723 |
13,711 |
$382K |
| D0330 |
Panoramic radiographic image |
4,775 |
4,773 |
$311K |
| D0274 |
Bitewings - four radiographic images |
4,446 |
4,445 |
$184K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,347 |
409 |
$144K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,441 |
2,439 |
$94K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
256 |
159 |
$46K |
| D0240 |
|
1,411 |
740 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
200 |
146 |
$19K |
| D9420 |
|
224 |
224 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
243 |
243 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
170 |
170 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
90 |
90 |
$898.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
29 |
29 |
$598.00 |