| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
44,774 |
44,000 |
$1.51M |
| D0120 |
Periodic oral evaluation - established patient |
46,263 |
45,499 |
$1.12M |
| D1206 |
Topical application of fluoride varnish |
51,462 |
50,602 |
$1.08M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,023 |
2,287 |
$974K |
| D8670 |
Periodic orthodontic treatment visit |
4,861 |
4,499 |
$427K |
| D9248 |
|
4,360 |
4,213 |
$365K |
| D1110 |
Prophylaxis - adult |
7,852 |
7,717 |
$336K |
| D0272 |
Bitewings - two radiographic images |
18,615 |
18,304 |
$330K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,057 |
1,239 |
$237K |
| D0330 |
Panoramic radiographic image |
4,731 |
4,641 |
$226K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,353 |
5,258 |
$154K |
| D0274 |
Bitewings - four radiographic images |
3,599 |
3,517 |
$99K |
| D1351 |
Sealant - per tooth |
3,288 |
1,112 |
$88K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,051 |
483 |
$64K |
| D8660 |
|
853 |
821 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,555 |
1,526 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,959 |
2,839 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
334 |
281 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
320 |
264 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
259 |
197 |
$18K |
| D2140 |
|
130 |
107 |
$8K |
| D1354 |
|
601 |
226 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
143 |
136 |
$4K |
| D9420 |
|
897 |
868 |
$615.00 |