| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
23,382 |
22,522 |
$1.17M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,484 |
2,490 |
$608K |
| D0120 |
Periodic oral evaluation - established patient |
22,734 |
22,087 |
$502K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,601 |
21,743 |
$330K |
| D1110 |
Prophylaxis - adult |
5,077 |
4,924 |
$253K |
| D0272 |
Bitewings - two radiographic images |
13,401 |
12,857 |
$238K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,168 |
2,110 |
$205K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,491 |
1,938 |
$190K |
| D0330 |
Panoramic radiographic image |
3,566 |
3,437 |
$167K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,763 |
4,235 |
$163K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,188 |
5,820 |
$159K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,853 |
1,930 |
$147K |
| D1206 |
Topical application of fluoride varnish |
4,388 |
4,339 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
6,872 |
6,523 |
$70K |
| D0274 |
Bitewings - four radiographic images |
2,280 |
2,178 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,813 |
3,550 |
$60K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,005 |
1,934 |
$49K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
689 |
433 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,251 |
1,152 |
$38K |
| D9420 |
|
596 |
553 |
$36K |
| D2332 |
|
404 |
230 |
$30K |
| D1351 |
Sealant - per tooth |
510 |
181 |
$9K |
| D9110 |
|
184 |
183 |
$5K |
| D2330 |
|
22 |
12 |
$1K |
| D9986 |
|
1,482 |
1,090 |
$0.00 |
| D9987 |
|
39 |
32 |
$0.00 |