| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,922 |
16,030 |
$858K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,418 |
2,157 |
$579K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,603 |
3,636 |
$426K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15,754 |
14,976 |
$420K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,361 |
3,037 |
$274K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,079 |
1,987 |
$222K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,310 |
5,785 |
$222K |
| D1206 |
Topical application of fluoride varnish |
13,645 |
12,957 |
$206K |
| D0330 |
Panoramic radiographic image |
4,223 |
4,017 |
$194K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,960 |
8,980 |
$138K |
| D0220 |
Intraoral - periapical first radiographic image |
11,422 |
10,640 |
$109K |
| D0274 |
Bitewings - four radiographic images |
4,139 |
4,004 |
$96K |
| D1351 |
Sealant - per tooth |
4,732 |
1,673 |
$92K |
| D9420 |
|
1,347 |
1,246 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,688 |
4,420 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,723 |
2,657 |
$71K |
| D1110 |
Prophylaxis - adult |
1,192 |
1,149 |
$62K |
| D2330 |
|
1,189 |
670 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,379 |
1,303 |
$46K |
| D2335 |
|
462 |
233 |
$41K |
| D0272 |
Bitewings - two radiographic images |
2,329 |
2,063 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
417 |
290 |
$32K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
482 |
245 |
$29K |
| D1354 |
|
2,019 |
1,087 |
$18K |
| D2390 |
|
184 |
84 |
$18K |
| D2331 |
|
162 |
108 |
$10K |
| D1510 |
|
54 |
38 |
$7K |
| D0603 |
|
752 |
702 |
$0.00 |
| D9996 |
|
18 |
16 |
$0.00 |