| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
60,356 |
60,356 |
$2.65M |
| D1208 |
Topical application of fluoride, excluding varnish |
76,841 |
76,841 |
$2.03M |
| D0120 |
Periodic oral evaluation - established patient |
68,160 |
68,159 |
$1.92M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,884 |
5,286 |
$1.20M |
| D1351 |
Sealant - per tooth |
17,232 |
7,931 |
$1.05M |
| D7140 |
Extraction, erupted tooth or exposed root |
9,546 |
7,260 |
$940K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
8,255 |
6,654 |
$912K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,410 |
5,302 |
$865K |
| D1110 |
Prophylaxis - adult |
16,984 |
16,984 |
$777K |
| D8670 |
Periodic orthodontic treatment visit |
3,929 |
3,697 |
$555K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,157 |
3,438 |
$526K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,306 |
3,839 |
$447K |
| D0272 |
Bitewings - two radiographic images |
20,170 |
20,170 |
$326K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,471 |
8,471 |
$325K |
| D0274 |
Bitewings - four radiographic images |
11,737 |
11,737 |
$288K |
| D0220 |
Intraoral - periapical first radiographic image |
11,968 |
11,934 |
$146K |
| D0330 |
Panoramic radiographic image |
3,374 |
3,373 |
$143K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,051 |
4,737 |
$108K |
| D0210 |
Intraoral - complete series of radiographic images |
6,371 |
6,358 |
$72K |
| D9110 |
|
1,851 |
1,846 |
$65K |
| D0340 |
|
1,424 |
1,423 |
$61K |
| D0470 |
|
1,301 |
1,300 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,073 |
1,070 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
209 |
185 |
$28K |
| D2140 |
|
294 |
271 |
$27K |
| D0350 |
|
1,336 |
1,335 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
768 |
768 |
$8K |
| D2160 |
|
54 |
51 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
97 |
97 |
$3K |
| D0601 |
|
172 |
172 |
$142.00 |
| D0602 |
|
14 |
14 |
$8.00 |
| D1999 |
|
16 |
16 |
$0.00 |