| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
32,998 |
32,935 |
$1.06M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,654 |
4,753 |
$898K |
| D0120 |
Periodic oral evaluation - established patient |
25,743 |
25,692 |
$589K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,298 |
5,094 |
$522K |
| D1206 |
Topical application of fluoride varnish |
27,725 |
27,670 |
$517K |
| D0272 |
Bitewings - two radiographic images |
24,270 |
24,230 |
$501K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,968 |
14,188 |
$413K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,662 |
2,929 |
$304K |
| D1351 |
Sealant - per tooth |
12,522 |
4,403 |
$295K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,021 |
8,009 |
$279K |
| D0220 |
Intraoral - periapical first radiographic image |
21,576 |
21,449 |
$247K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,423 |
3,199 |
$237K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,651 |
2,001 |
$210K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,718 |
19,248 |
$184K |
| D0240 |
|
9,511 |
5,731 |
$127K |
| D0274 |
Bitewings - four radiographic images |
3,902 |
3,886 |
$116K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,526 |
5,519 |
$99K |
| D0140 |
Limited oral evaluation - problem focused |
2,961 |
2,938 |
$88K |
| D0330 |
Panoramic radiographic image |
2,025 |
2,018 |
$76K |
| D7111 |
|
114 |
73 |
$5K |