| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
34,702 |
34,686 |
$2.50M |
| D1110 |
Prophylaxis - adult |
19,655 |
19,644 |
$1.87M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
15,008 |
5,133 |
$1.11M |
| D0210 |
Intraoral - complete series of radiographic images |
4,317 |
4,316 |
$1.01M |
| D0330 |
Panoramic radiographic image |
9,338 |
9,331 |
$796K |
| D0274 |
Bitewings - four radiographic images |
19,740 |
19,730 |
$537K |
| D9420 |
|
1,273 |
1,269 |
$342K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,987 |
5,982 |
$290K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,564 |
2,076 |
$218K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,476 |
3,475 |
$196K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,764 |
1,489 |
$127K |
| D2934 |
|
394 |
121 |
$122K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,947 |
1,302 |
$97K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
561 |
484 |
$84K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,259 |
999 |
$81K |
| D0140 |
Limited oral evaluation - problem focused |
2,474 |
2,455 |
$72K |
| D1351 |
Sealant - per tooth |
86,891 |
16,855 |
$44K |
| D2332 |
|
369 |
257 |
$36K |
| D2140 |
|
359 |
304 |
$18K |
| D1206 |
Topical application of fluoride varnish |
48,830 |
48,774 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
44,748 |
44,727 |
$3K |
| D2160 |
|
15 |
14 |
$1K |
| D7111 |
|
35 |
25 |
$995.96 |
| D2940 |
|
16 |
12 |
$624.23 |
| D0220 |
Intraoral - periapical first radiographic image |
44,265 |
43,924 |
$624.06 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,218 |
825 |
$602.89 |
| D1354 |
|
77 |
26 |
$459.00 |
| D0272 |
Bitewings - two radiographic images |
27,438 |
27,402 |
$358.72 |
| D1208 |
Topical application of fluoride, excluding varnish |
3,842 |
3,841 |
$13.55 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15,576 |
14,456 |
$3.04 |
| D9986 |
|
683 |
668 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
48,669 |
41,078 |
$-609.03 |