| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
29,811 |
29,766 |
$1.16M |
| D0120 |
Periodic oral evaluation - established patient |
25,467 |
25,439 |
$801K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,709 |
2,457 |
$472K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,522 |
2,399 |
$278K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,276 |
3,265 |
$253K |
| D0140 |
Limited oral evaluation - problem focused |
3,984 |
3,928 |
$146K |
| D2934 |
|
460 |
125 |
$145K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,093 |
2,053 |
$133K |
| D9420 |
|
1,016 |
1,012 |
$122K |
| D0330 |
Panoramic radiographic image |
1,259 |
1,258 |
$121K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,735 |
977 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
753 |
751 |
$32K |
| D1110 |
Prophylaxis - adult |
268 |
268 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
29,885 |
29,830 |
$28K |
| D0145 |
Oral evaluation for a patient under three years of age |
434 |
433 |
$27K |
| D1351 |
Sealant - per tooth |
13,776 |
3,149 |
$26K |
| D0272 |
Bitewings - two radiographic images |
19,868 |
19,838 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
22,606 |
22,234 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,369 |
16,615 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,915 |
5,734 |
$13K |
| D1510 |
|
34 |
25 |
$8K |
| D4346 |
|
24 |
24 |
$3K |
| D0274 |
Bitewings - four radiographic images |
784 |
783 |
$1K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
523 |
261 |
$999.46 |
| D1354 |
|
616 |
161 |
$187.00 |
| D1330 |
|
178 |
178 |
$0.00 |