| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
22,948 |
22,875 |
$1.07M |
| D0120 |
Periodic oral evaluation - established patient |
15,268 |
15,219 |
$983K |
| D1310 |
|
13,739 |
13,706 |
$622K |
| D1206 |
Topical application of fluoride varnish |
22,077 |
22,010 |
$440K |
| D0230 |
Intraoral - periapical each additional radiographic image |
74,180 |
16,450 |
$337K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,776 |
4,764 |
$313K |
| D1351 |
Sealant - per tooth |
7,178 |
1,872 |
$230K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,664 |
2,525 |
$230K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,476 |
3,463 |
$224K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,399 |
5,253 |
$213K |
| D0603 |
|
13,684 |
13,650 |
$201K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,811 |
1,902 |
$151K |
| D9993 |
|
2,213 |
2,212 |
$133K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,140 |
874 |
$128K |
| D0272 |
Bitewings - two radiographic images |
9,176 |
9,140 |
$107K |
| D0220 |
Intraoral - periapical first radiographic image |
9,144 |
8,912 |
$100K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,838 |
1,241 |
$95K |
| D0350 |
|
4,012 |
2,613 |
$39K |
| D0274 |
Bitewings - four radiographic images |
985 |
985 |
$21K |
| D9430 |
|
594 |
576 |
$19K |
| D1354 |
|
1,074 |
384 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
51 |
48 |
$5K |
| D2330 |
|
53 |
40 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$576.00 |
| D1999 |
|
245 |
212 |
$38.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
245 |
212 |
$1.44 |