| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
32,685 |
32,086 |
$1.84M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,774 |
2,501 |
$1.24M |
| D0120 |
Periodic oral evaluation - established patient |
24,631 |
24,164 |
$599K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,238 |
3,404 |
$432K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,822 |
10,615 |
$332K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,414 |
19,991 |
$305K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,239 |
2,059 |
$303K |
| D1206 |
Topical application of fluoride varnish |
13,890 |
13,712 |
$301K |
| D0272 |
Bitewings - two radiographic images |
13,001 |
12,743 |
$253K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,371 |
1,976 |
$204K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,493 |
5,096 |
$203K |
| D1351 |
Sealant - per tooth |
8,732 |
2,624 |
$189K |
| D0330 |
Panoramic radiographic image |
4,147 |
4,051 |
$181K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,185 |
4,705 |
$125K |
| D0220 |
Intraoral - periapical first radiographic image |
9,151 |
8,672 |
$108K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,067 |
556 |
$82K |
| D0140 |
Limited oral evaluation - problem focused |
1,927 |
1,856 |
$74K |
| D1110 |
Prophylaxis - adult |
1,404 |
1,356 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,651 |
1,615 |
$50K |
| D9420 |
|
929 |
887 |
$48K |
| D9248 |
|
261 |
240 |
$20K |
| D1510 |
|
20 |
12 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
26 |
$3K |
| D8660 |
|
42 |
41 |
$3K |
| D2332 |
|
21 |
13 |
$2K |
| D1354 |
|
142 |
41 |
$2K |
| D8999 |
|
14 |
14 |
$1K |
| D2330 |
|
23 |
12 |
$915.20 |
| D9986 |
|
50 |
50 |
$17.25 |