| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
47,376 |
47,376 |
$1.62M |
| D0120 |
Periodic oral evaluation - established patient |
61,184 |
61,184 |
$1.43M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,120 |
9,938 |
$1.38M |
| D1206 |
Topical application of fluoride varnish |
68,509 |
68,509 |
$1.12M |
| D1110 |
Prophylaxis - adult |
21,942 |
21,942 |
$1.08M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12,280 |
9,236 |
$1.07M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,208 |
4,650 |
$1.05M |
| D7140 |
Extraction, erupted tooth or exposed root |
10,377 |
6,512 |
$997K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
29,193 |
27,973 |
$926K |
| D0272 |
Bitewings - two radiographic images |
30,930 |
30,930 |
$582K |
| D0274 |
Bitewings - four radiographic images |
19,817 |
19,817 |
$546K |
| D1351 |
Sealant - per tooth |
17,077 |
5,453 |
$500K |
| D0330 |
Panoramic radiographic image |
7,318 |
7,317 |
$330K |
| D0220 |
Intraoral - periapical first radiographic image |
19,871 |
19,736 |
$257K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,611 |
5,611 |
$231K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,781 |
11,399 |
$219K |
| D0140 |
Limited oral evaluation - problem focused |
4,504 |
4,471 |
$172K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,152 |
720 |
$94K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,859 |
1,859 |
$81K |
| D9420 |
|
576 |
576 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
311 |
267 |
$42K |
| D2330 |
|
564 |
375 |
$39K |
| D0240 |
|
1,280 |
964 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
185 |
185 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
89 |
89 |
$1K |
| D7111 |
|
14 |
14 |
$938.00 |
| D9920 |
|
12 |
12 |
$852.00 |