| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
38,688 |
38,503 |
$1.88M |
| D0120 |
Periodic oral evaluation - established patient |
23,029 |
22,908 |
$1.67M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,069 |
3,362 |
$963K |
| D1310 |
|
17,760 |
17,676 |
$814K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,746 |
11,696 |
$805K |
| D1351 |
Sealant - per tooth |
20,968 |
6,665 |
$734K |
| D0230 |
Intraoral - periapical each additional radiographic image |
34,126 |
33,874 |
$701K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
10,265 |
5,592 |
$685K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,932 |
14,613 |
$593K |
| D2140 |
|
8,310 |
4,884 |
$448K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,581 |
4,336 |
$432K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,226 |
1,893 |
$418K |
| D1206 |
Topical application of fluoride varnish |
14,258 |
14,194 |
$414K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,891 |
23,770 |
$311K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,067 |
4,048 |
$293K |
| D0220 |
Intraoral - periapical first radiographic image |
20,615 |
20,458 |
$247K |
| D9993 |
|
2,916 |
2,916 |
$189K |
| D0603 |
|
12,503 |
12,435 |
$187K |
| D0274 |
Bitewings - four radiographic images |
8,320 |
8,270 |
$179K |
| D0350 |
|
9,459 |
8,658 |
$153K |
| D0210 |
Intraoral - complete series of radiographic images |
3,189 |
3,178 |
$153K |
| D2330 |
|
1,773 |
1,016 |
$137K |
| D0272 |
Bitewings - two radiographic images |
5,749 |
5,712 |
$69K |
| D0602 |
|
3,959 |
3,946 |
$59K |
| D1510 |
|
259 |
216 |
$54K |
| D1320 |
|
4,169 |
4,169 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
286 |
192 |
$19K |
| D2160 |
|
174 |
128 |
$14K |
| D9430 |
|
285 |
279 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
90 |
73 |
$5K |
| D2331 |
|
40 |
24 |
$3K |