| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
24,680 |
24,675 |
$903K |
| D0120 |
Periodic oral evaluation - established patient |
33,198 |
33,191 |
$787K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,236 |
7,700 |
$699K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,972 |
5,252 |
$554K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,623 |
6,681 |
$407K |
| D1110 |
Prophylaxis - adult |
8,150 |
8,148 |
$373K |
| D0274 |
Bitewings - four radiographic images |
14,749 |
14,747 |
$345K |
| D0220 |
Intraoral - periapical first radiographic image |
29,821 |
29,812 |
$343K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,827 |
3,610 |
$334K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,528 |
2,192 |
$274K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,893 |
21,889 |
$262K |
| D2332 |
|
2,230 |
1,953 |
$256K |
| D1351 |
Sealant - per tooth |
3,553 |
2,023 |
$232K |
| D0272 |
Bitewings - two radiographic images |
15,317 |
15,313 |
$218K |
| D1206 |
Topical application of fluoride varnish |
8,082 |
8,079 |
$210K |
| D3240 |
|
991 |
883 |
$210K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,687 |
29,675 |
$171K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,330 |
2,969 |
$156K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,892 |
1,774 |
$142K |
| D2335 |
|
564 |
487 |
$98K |
| D2140 |
|
1,195 |
1,104 |
$69K |
| D2160 |
|
539 |
526 |
$48K |
| D2331 |
|
351 |
284 |
$29K |
| D2330 |
|
172 |
149 |
$10K |
| D9110 |
|
321 |
321 |
$7K |
| D9995 |
|
72 |
67 |
$2K |