| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
20,069 |
19,825 |
$1.02M |
| D1208 |
Topical application of fluoride, excluding varnish |
20,469 |
20,226 |
$600K |
| D0120 |
Periodic oral evaluation - established patient |
18,990 |
18,772 |
$557K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,610 |
988 |
$456K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,963 |
1,690 |
$298K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,138 |
2,288 |
$293K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,229 |
1,524 |
$262K |
| D9450 |
|
11,027 |
10,257 |
$259K |
| D0272 |
Bitewings - two radiographic images |
6,723 |
6,640 |
$203K |
| D0330 |
Panoramic radiographic image |
2,288 |
2,257 |
$201K |
| D1351 |
Sealant - per tooth |
5,006 |
2,752 |
$184K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,418 |
6,841 |
$153K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,076 |
2,033 |
$119K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
980 |
653 |
$90K |
| D0140 |
Limited oral evaluation - problem focused |
1,376 |
1,346 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
3,121 |
3,043 |
$62K |
| D1110 |
Prophylaxis - adult |
811 |
794 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,313 |
2,214 |
$37K |
| D2140 |
|
314 |
186 |
$24K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
67 |
49 |
$7K |
| D0274 |
Bitewings - four radiographic images |
96 |
95 |
$4K |