| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
31,210 |
30,908 |
$777K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,080 |
2,696 |
$490K |
| D0120 |
Periodic oral evaluation - established patient |
27,505 |
27,234 |
$426K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,951 |
3,349 |
$383K |
| D1206 |
Topical application of fluoride varnish |
22,969 |
22,733 |
$351K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,132 |
11,308 |
$316K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,312 |
3,061 |
$314K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,839 |
3,251 |
$312K |
| D1351 |
Sealant - per tooth |
13,025 |
4,115 |
$310K |
| D1110 |
Prophylaxis - adult |
6,701 |
6,640 |
$265K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,534 |
14,411 |
$248K |
| D0272 |
Bitewings - two radiographic images |
13,710 |
13,557 |
$222K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,540 |
7,457 |
$169K |
| D9920 |
|
3,399 |
3,280 |
$142K |
| D0210 |
Intraoral - complete series of radiographic images |
3,690 |
3,222 |
$96K |
| D0330 |
Panoramic radiographic image |
2,096 |
2,067 |
$84K |
| D0140 |
Limited oral evaluation - problem focused |
3,465 |
3,383 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
7,791 |
7,541 |
$69K |
| D8670 |
Periodic orthodontic treatment visit |
163 |
163 |
$66K |
| D0274 |
Bitewings - four radiographic images |
2,876 |
2,850 |
$63K |
| D9310 |
|
775 |
768 |
$47K |
| D3120 |
|
2,729 |
1,730 |
$43K |
| D0240 |
|
4,185 |
2,244 |
$41K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
361 |
171 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,171 |
1,906 |
$20K |
| D1355 |
|
677 |
215 |
$14K |
| D0170 |
|
845 |
840 |
$14K |
| D9994 |
|
2,680 |
2,641 |
$12K |
| D2390 |
|
84 |
53 |
$11K |
| D8680 |
|
27 |
27 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
747 |
741 |
$11K |
| D2940 |
|
244 |
154 |
$10K |
| D1510 |
|
57 |
43 |
$8K |
| D9910 |
|
226 |
226 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
48 |
39 |
$6K |
| D2330 |
|
39 |
24 |
$3K |
| D1354 |
|
1,092 |
389 |
$686.40 |
| D9630 |
|
773 |
752 |
$0.00 |
| D7111 |
|
143 |
92 |
$0.00 |
| D2331 |
|
13 |
13 |
$0.00 |
| D9110 |
|
123 |
123 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
35 |
31 |
$0.00 |
| D9996 |
|
23 |
23 |
$0.00 |