| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
21,038 |
20,981 |
$1.05M |
| D1120 |
Prophylaxis - child |
29,163 |
29,127 |
$1.02M |
| D1206 |
Topical application of fluoride varnish |
50,446 |
50,353 |
$825K |
| D0120 |
Periodic oral evaluation - established patient |
34,679 |
34,604 |
$810K |
| D1351 |
Sealant - per tooth |
23,681 |
8,966 |
$711K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,402 |
4,589 |
$663K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17,267 |
16,211 |
$561K |
| D0274 |
Bitewings - four radiographic images |
20,636 |
20,606 |
$557K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,231 |
3,198 |
$538K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,788 |
12,774 |
$524K |
| D0330 |
Panoramic radiographic image |
9,577 |
9,567 |
$459K |
| D0272 |
Bitewings - two radiographic images |
20,274 |
20,253 |
$379K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,290 |
3,479 |
$374K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,132 |
2,272 |
$245K |
| D2140 |
|
2,378 |
1,881 |
$141K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,229 |
3,223 |
$139K |
| D0220 |
Intraoral - periapical first radiographic image |
9,913 |
9,840 |
$125K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
902 |
723 |
$116K |
| D0140 |
Limited oral evaluation - problem focused |
1,629 |
1,620 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
496 |
417 |
$49K |
| D2160 |
|
273 |
208 |
$26K |
| D7111 |
|
377 |
293 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,457 |
903 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
21 |
16 |
$2K |
| D0240 |
|
12 |
12 |
$227.28 |