| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
20,532 |
20,220 |
$857K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,562 |
4,044 |
$773K |
| D0120 |
Periodic oral evaluation - established patient |
26,494 |
26,105 |
$759K |
| D1208 |
Topical application of fluoride, excluding varnish |
27,785 |
27,378 |
$629K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,436 |
1,635 |
$521K |
| D1110 |
Prophylaxis - adult |
7,367 |
7,265 |
$423K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,246 |
1,442 |
$228K |
| D1351 |
Sealant - per tooth |
6,688 |
2,079 |
$219K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,354 |
1,775 |
$215K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,499 |
1,525 |
$207K |
| D0272 |
Bitewings - two radiographic images |
10,111 |
9,954 |
$149K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
831 |
672 |
$123K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,789 |
4,947 |
$102K |
| D0274 |
Bitewings - four radiographic images |
4,172 |
4,110 |
$91K |
| D0140 |
Limited oral evaluation - problem focused |
1,960 |
1,905 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,579 |
1,557 |
$81K |
| D1330 |
|
9,183 |
9,017 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
1,827 |
1,778 |
$16K |
| D0240 |
|
1,514 |
1,482 |
$14K |
| D9310 |
|
144 |
143 |
$7K |
| D1206 |
Topical application of fluoride varnish |
135 |
134 |
$3K |