| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
24,030 |
23,926 |
$854K |
| D0120 |
Periodic oral evaluation - established patient |
29,454 |
29,316 |
$725K |
| D1206 |
Topical application of fluoride varnish |
34,551 |
34,381 |
$699K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,816 |
1,259 |
$637K |
| D0350 |
|
6,343 |
3,625 |
$620K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,995 |
2,489 |
$536K |
| D1110 |
Prophylaxis - adult |
10,395 |
10,349 |
$505K |
| D1351 |
Sealant - per tooth |
12,149 |
4,097 |
$442K |
| D0220 |
Intraoral - periapical first radiographic image |
24,668 |
24,414 |
$317K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,655 |
21,500 |
$310K |
| D0272 |
Bitewings - two radiographic images |
12,387 |
12,318 |
$263K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,489 |
1,681 |
$260K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,912 |
5,621 |
$187K |
| D0274 |
Bitewings - four radiographic images |
5,784 |
5,756 |
$176K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,036 |
3,023 |
$125K |
| D3120 |
|
3,253 |
663 |
$123K |
| D0330 |
Panoramic radiographic image |
1,696 |
1,687 |
$91K |
| D7140 |
Extraction, erupted tooth or exposed root |
675 |
361 |
$68K |
| D0210 |
Intraoral - complete series of radiographic images |
2,059 |
2,034 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
1,587 |
1,570 |
$55K |
| D0240 |
|
1,367 |
1,360 |
$47K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
389 |
112 |
$35K |
| D1353 |
|
989 |
400 |
$35K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,051 |
1,050 |
$34K |
| D0190 |
|
1,286 |
1,284 |
$22K |
| D9310 |
|
447 |
447 |
$17K |
| D7240 |
Removal of impacted tooth - completely bony |
44 |
12 |
$12K |
| D9219 |
|
160 |
159 |
$7K |
| D7111 |
|
98 |
77 |
$5K |
| D9940 |
|
14 |
14 |
$4K |
| D9945 |
|
12 |
12 |
$3K |
| D4346 |
|
60 |
60 |
$3K |
| D9243 |
|
13 |
13 |
$3K |
| D9239 |
|
13 |
13 |
$1K |
| D9110 |
|
21 |
21 |
$1K |
| D1354 |
|
27 |
12 |
$154.17 |