| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
23,969 |
23,571 |
$795K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,000 |
2,129 |
$649K |
| D0120 |
Periodic oral evaluation - established patient |
25,738 |
25,364 |
$606K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,233 |
3,756 |
$363K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,904 |
16,645 |
$341K |
| D1206 |
Topical application of fluoride varnish |
12,788 |
12,566 |
$258K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,066 |
8,722 |
$254K |
| D1110 |
Prophylaxis - adult |
6,092 |
5,999 |
$252K |
| D0272 |
Bitewings - two radiographic images |
13,187 |
12,961 |
$231K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,716 |
1,993 |
$214K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,701 |
1,348 |
$192K |
| D1351 |
Sealant - per tooth |
6,392 |
2,054 |
$173K |
| D0330 |
Panoramic radiographic image |
2,886 |
2,842 |
$130K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,180 |
4,079 |
$118K |
| D0220 |
Intraoral - periapical first radiographic image |
7,043 |
6,854 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,222 |
739 |
$83K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
892 |
502 |
$71K |
| D0274 |
Bitewings - four radiographic images |
2,207 |
2,176 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
2,051 |
1,998 |
$44K |
| D9248 |
|
514 |
477 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,382 |
4,040 |
$41K |
| D2332 |
|
173 |
106 |
$14K |
| D2330 |
|
64 |
41 |
$3K |