| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
43,423 |
41,137 |
$2.09M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,733 |
3,318 |
$1.18M |
| D0120 |
Periodic oral evaluation - established patient |
37,998 |
35,968 |
$1.05M |
| D1206 |
Topical application of fluoride varnish |
32,780 |
31,613 |
$796K |
| D1351 |
Sealant - per tooth |
20,309 |
6,092 |
$757K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,575 |
3,478 |
$680K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,339 |
9,919 |
$577K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,415 |
3,350 |
$554K |
| D0272 |
Bitewings - two radiographic images |
17,908 |
16,890 |
$480K |
| D0330 |
Panoramic radiographic image |
6,784 |
6,321 |
$456K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,708 |
14,307 |
$427K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,256 |
11,039 |
$238K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,625 |
1,874 |
$224K |
| D1110 |
Prophylaxis - adult |
3,120 |
2,942 |
$204K |
| D0140 |
Limited oral evaluation - problem focused |
4,251 |
3,957 |
$183K |
| D1510 |
|
928 |
509 |
$164K |
| D0274 |
Bitewings - four radiographic images |
3,331 |
3,206 |
$128K |
| D0220 |
Intraoral - periapical first radiographic image |
7,107 |
6,458 |
$123K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
989 |
578 |
$89K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
357 |
311 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,510 |
1,851 |
$41K |
| D1354 |
|
1,934 |
698 |
$28K |
| D2332 |
|
173 |
60 |
$19K |
| D2140 |
|
125 |
79 |
$9K |
| D9945 |
|
16 |
16 |
$5K |
| D0240 |
|
68 |
65 |
$1K |
| D0270 |
|
13 |
13 |
$189.18 |
| D0603 |
|
45,913 |
43,409 |
$0.00 |
| D0602 |
|
146 |
146 |
$0.00 |
| D0350 |
|
1,125 |
1,105 |
$0.00 |
| D8660 |
|
19 |
19 |
$0.00 |
| D0340 |
|
53 |
53 |
$0.00 |