| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
29,912 |
29,713 |
$765K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,104 |
8,488 |
$680K |
| D0120 |
Periodic oral evaluation - established patient |
26,885 |
26,717 |
$536K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,583 |
6,199 |
$374K |
| D1351 |
Sealant - per tooth |
22,821 |
4,688 |
$356K |
| D1208 |
Topical application of fluoride, excluding varnish |
32,151 |
31,942 |
$348K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,457 |
5,659 |
$322K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,707 |
1,623 |
$224K |
| D9248 |
|
1,789 |
1,701 |
$193K |
| D3240 |
|
2,055 |
1,264 |
$144K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,313 |
6,259 |
$113K |
| D0601 |
|
11,664 |
11,618 |
$103K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,148 |
1,565 |
$101K |
| D0272 |
Bitewings - two radiographic images |
12,314 |
12,236 |
$89K |
| D0140 |
Limited oral evaluation - problem focused |
3,011 |
2,951 |
$62K |
| D9920 |
|
3,327 |
3,020 |
$57K |
| D1110 |
Prophylaxis - adult |
2,451 |
2,434 |
$55K |
| D2332 |
|
1,101 |
667 |
$52K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
589 |
388 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,221 |
2,116 |
$35K |
| D0602 |
|
3,719 |
3,696 |
$33K |
| D2335 |
|
604 |
365 |
$32K |
| D0603 |
|
3,827 |
3,774 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,954 |
1,926 |
$26K |
| D4355 |
|
314 |
314 |
$17K |
| D2330 |
|
443 |
299 |
$16K |
| D7510 |
|
491 |
454 |
$14K |
| D2331 |
|
358 |
228 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
463 |
248 |
$14K |
| D0330 |
Panoramic radiographic image |
533 |
522 |
$12K |
| D2932 |
|
91 |
49 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,506 |
1,472 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
425 |
421 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,014 |
998 |
$3K |
| D4346 |
|
82 |
80 |
$2K |
| D3230 |
|
24 |
13 |
$1K |
| D1999 |
|
98 |
96 |
$0.00 |
| D1330 |
|
51 |
37 |
$0.00 |