| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
23,015 |
22,940 |
$818K |
| D0120 |
Periodic oral evaluation - established patient |
21,083 |
21,032 |
$522K |
| D1206 |
Topical application of fluoride varnish |
24,954 |
24,870 |
$505K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,284 |
1,121 |
$409K |
| D8660 |
|
1,636 |
1,636 |
$230K |
| D1351 |
Sealant - per tooth |
6,101 |
1,754 |
$221K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,491 |
6,451 |
$206K |
| D1110 |
Prophylaxis - adult |
3,931 |
3,922 |
$194K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,965 |
3,941 |
$160K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,554 |
878 |
$153K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,185 |
4,028 |
$132K |
| D0220 |
Intraoral - periapical first radiographic image |
9,741 |
9,633 |
$123K |
| D0272 |
Bitewings - two radiographic images |
5,636 |
5,610 |
$119K |
| D0330 |
Panoramic radiographic image |
1,902 |
1,895 |
$100K |
| D0140 |
Limited oral evaluation - problem focused |
2,248 |
2,236 |
$79K |
| D0340 |
|
1,183 |
1,182 |
$69K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
482 |
327 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
570 |
341 |
$57K |
| D8220 |
|
111 |
111 |
$50K |
| D0240 |
|
1,061 |
1,058 |
$33K |
| D0350 |
|
969 |
967 |
$31K |
| D0145 |
Oral evaluation for a patient under three years of age |
776 |
773 |
$25K |
| D0274 |
Bitewings - four radiographic images |
744 |
744 |
$23K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
256 |
143 |
$20K |
| D8670 |
Periodic orthodontic treatment visit |
140 |
140 |
$19K |
| D2934 |
|
73 |
16 |
$11K |
| D1354 |
|
202 |
72 |
$10K |
| D9420 |
|
69 |
68 |
$8K |
| D0470 |
|
90 |
90 |
$4K |