| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
83,966 |
83,415 |
$2.86M |
| D0120 |
Periodic oral evaluation - established patient |
107,054 |
106,298 |
$2.64M |
| D1208 |
Topical application of fluoride, excluding varnish |
100,641 |
99,983 |
$2.11M |
| D1351 |
Sealant - per tooth |
58,531 |
21,432 |
$1.74M |
| D1110 |
Prophylaxis - adult |
29,165 |
28,991 |
$1.27M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18,434 |
4,656 |
$1.15M |
| D0210 |
Intraoral - complete series of radiographic images |
18,569 |
18,469 |
$1.08M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,645 |
2,251 |
$756K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,663 |
3,472 |
$567K |
| D2140 |
|
8,725 |
2,855 |
$549K |
| D0272 |
Bitewings - two radiographic images |
29,959 |
29,757 |
$526K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,164 |
2,009 |
$516K |
| D0274 |
Bitewings - four radiographic images |
15,275 |
15,196 |
$404K |
| D0330 |
Panoramic radiographic image |
8,364 |
8,338 |
$384K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,171 |
1,964 |
$313K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
460 |
405 |
$267K |
| D1206 |
Topical application of fluoride varnish |
12,278 |
12,215 |
$259K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,199 |
6,174 |
$185K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,183 |
1,519 |
$134K |
| D2931 |
|
616 |
512 |
$88K |
| D2950 |
|
700 |
568 |
$83K |
| D2330 |
|
949 |
525 |
$59K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
257 |
187 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
579 |
573 |
$14K |
| D2390 |
|
49 |
25 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
288 |
287 |
$4K |
| D1354 |
|
206 |
42 |
$2K |
| D9110 |
|
32 |
32 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
74 |
74 |
$2K |
| D9995 |
|
43 |
43 |
$0.00 |