| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
32,167 |
31,738 |
$1.41M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,747 |
2,998 |
$1.23M |
| D1351 |
Sealant - per tooth |
32,714 |
6,528 |
$1.13M |
| D0120 |
Periodic oral evaluation - established patient |
34,829 |
34,393 |
$1.04M |
| D1208 |
Topical application of fluoride, excluding varnish |
40,201 |
39,672 |
$926K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,391 |
2,966 |
$491K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,887 |
2,746 |
$477K |
| D1110 |
Prophylaxis - adult |
7,346 |
7,254 |
$451K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,668 |
3,148 |
$445K |
| D1206 |
Topical application of fluoride varnish |
15,592 |
15,360 |
$390K |
| D0272 |
Bitewings - two radiographic images |
24,821 |
24,499 |
$383K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,588 |
5,498 |
$295K |
| D0220 |
Intraoral - periapical first radiographic image |
25,547 |
25,053 |
$257K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,232 |
9,572 |
$188K |
| D0274 |
Bitewings - four radiographic images |
6,884 |
6,796 |
$157K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,720 |
22,399 |
$151K |
| D0140 |
Limited oral evaluation - problem focused |
3,372 |
3,239 |
$149K |
| D1330 |
|
8,339 |
8,269 |
$56K |
| D0240 |
|
2,151 |
2,097 |
$37K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
522 |
263 |
$37K |
| D3120 |
|
986 |
702 |
$34K |
| D2335 |
|
188 |
66 |
$30K |
| D0330 |
Panoramic radiographic image |
569 |
569 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
52 |
40 |
$8K |
| D9420 |
|
464 |
458 |
$7K |
| D0270 |
|
30 |
29 |
$270.00 |
| D9110 |
|
13 |
13 |
$260.00 |