| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,465 |
9,718 |
$320K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,342 |
916 |
$259K |
| D0120 |
Periodic oral evaluation - established patient |
10,432 |
9,717 |
$234K |
| D1206 |
Topical application of fluoride varnish |
12,024 |
11,649 |
$231K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,661 |
1,085 |
$119K |
| D0210 |
Intraoral - complete series of radiographic images |
1,845 |
1,789 |
$101K |
| D1110 |
Prophylaxis - adult |
2,109 |
2,069 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,950 |
2,872 |
$81K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,098 |
679 |
$69K |
| D9248 |
|
1,068 |
977 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,121 |
743 |
$68K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
807 |
459 |
$64K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,408 |
2,283 |
$56K |
| D0272 |
Bitewings - two radiographic images |
2,210 |
2,148 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,175 |
1,153 |
$32K |
| D2929 |
|
256 |
77 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,784 |
1,729 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
683 |
665 |
$15K |
| D0330 |
Panoramic radiographic image |
282 |
257 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,009 |
512 |
$9K |
| D1351 |
Sealant - per tooth |
241 |
80 |
$6K |
| D1510 |
|
34 |
29 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
16 |
16 |
$366.00 |