| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
19,248 |
18,827 |
$1.02M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,348 |
2,150 |
$840K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15,899 |
15,514 |
$453K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,051 |
19,614 |
$315K |
| D9248 |
|
2,951 |
2,723 |
$314K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,820 |
2,378 |
$274K |
| D0272 |
Bitewings - two radiographic images |
10,670 |
10,388 |
$199K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,634 |
12,630 |
$172K |
| D0330 |
Panoramic radiographic image |
3,276 |
3,220 |
$166K |
| D0220 |
Intraoral - periapical first radiographic image |
14,468 |
14,052 |
$159K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,522 |
3,245 |
$132K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,736 |
1,417 |
$119K |
| D0120 |
Periodic oral evaluation - established patient |
3,193 |
3,168 |
$85K |
| D9420 |
|
1,088 |
1,061 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,258 |
1,026 |
$69K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,046 |
692 |
$67K |
| D1351 |
Sealant - per tooth |
3,038 |
743 |
$60K |
| D1110 |
Prophylaxis - adult |
830 |
814 |
$45K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,716 |
1,680 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
874 |
857 |
$32K |
| D0274 |
Bitewings - four radiographic images |
68 |
68 |
$2K |
| D2330 |
|
16 |
12 |
$800.80 |
| D9986 |
|
2,755 |
2,629 |
$0.00 |