| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,187 |
11,908 |
$622K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,607 |
1,219 |
$402K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,562 |
2,736 |
$300K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,988 |
8,738 |
$242K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,049 |
12,727 |
$202K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,212 |
1,669 |
$183K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,864 |
4,333 |
$141K |
| D0330 |
Panoramic radiographic image |
2,584 |
2,508 |
$135K |
| D1351 |
Sealant - per tooth |
6,607 |
2,010 |
$135K |
| D0272 |
Bitewings - two radiographic images |
5,893 |
5,734 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
3,916 |
3,874 |
$100K |
| D0220 |
Intraoral - periapical first radiographic image |
8,751 |
8,484 |
$90K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,503 |
7,109 |
$88K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,069 |
513 |
$68K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
813 |
618 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,210 |
1,166 |
$42K |
| D1110 |
Prophylaxis - adult |
634 |
627 |
$34K |
| D0274 |
Bitewings - four radiographic images |
696 |
687 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
319 |
258 |
$17K |
| D1510 |
|
93 |
84 |
$13K |
| D2332 |
|
124 |
69 |
$10K |
| D9420 |
|
79 |
72 |
$4K |