| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,845 |
12,667 |
$673K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,773 |
1,254 |
$349K |
| D1110 |
Prophylaxis - adult |
4,949 |
4,879 |
$320K |
| D0330 |
Panoramic radiographic image |
3,749 |
3,663 |
$305K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,917 |
1,994 |
$195K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,513 |
1,898 |
$123K |
| D1351 |
Sealant - per tooth |
10,013 |
3,906 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,661 |
1,077 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
14,997 |
14,811 |
$110K |
| D0240 |
|
12,173 |
9,369 |
$109K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,125 |
2,075 |
$67K |
| D1206 |
Topical application of fluoride varnish |
17,486 |
17,240 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
295 |
295 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,064 |
819 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
9,542 |
9,349 |
$47K |
| D2140 |
|
1,226 |
965 |
$46K |
| D0145 |
Oral evaluation for a patient under three years of age |
550 |
543 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,337 |
4,026 |
$44K |
| D0603 |
|
5,509 |
5,423 |
$31K |
| D1330 |
|
17,713 |
17,455 |
$25K |
| D0274 |
Bitewings - four radiographic images |
8,137 |
8,022 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
1,556 |
1,521 |
$22K |
| D0272 |
Bitewings - two radiographic images |
8,822 |
8,689 |
$16K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,621 |
1,141 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,210 |
8,065 |
$13K |
| D1510 |
|
96 |
89 |
$12K |
| D9920 |
|
1,600 |
1,489 |
$11K |
| D2160 |
|
79 |
71 |
$9K |
| D2331 |
|
165 |
123 |
$9K |
| D2330 |
|
210 |
178 |
$9K |
| D2390 |
|
52 |
26 |
$8K |
| D9999 |
Unspecified adjunctive procedure, by report |
270 |
270 |
$6K |
| D1999 |
|
33 |
33 |
$2K |
| D0601 |
|
813 |
800 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
41 |
41 |
$820.00 |
| D9995 |
|
12 |
12 |
$417.06 |
| D2920 |
|
13 |
12 |
$202.00 |
| D0602 |
|
295 |
293 |
$175.00 |
| D9986 |
|
167 |
159 |
$0.00 |