| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
34,015 |
33,805 |
$1.28M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,754 |
4,785 |
$1.17M |
| D0120 |
Periodic oral evaluation - established patient |
30,671 |
30,474 |
$903K |
| D1206 |
Topical application of fluoride varnish |
18,278 |
18,193 |
$499K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,714 |
10,807 |
$458K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,089 |
3,693 |
$449K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,351 |
19,193 |
$402K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,804 |
8,053 |
$280K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,108 |
5,086 |
$262K |
| D1351 |
Sealant - per tooth |
7,573 |
2,366 |
$247K |
| D0272 |
Bitewings - two radiographic images |
10,957 |
10,660 |
$240K |
| D0330 |
Panoramic radiographic image |
3,582 |
3,527 |
$216K |
| D1110 |
Prophylaxis - adult |
3,921 |
3,872 |
$209K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,544 |
1,458 |
$201K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,429 |
1,781 |
$175K |
| D0220 |
Intraoral - periapical first radiographic image |
11,526 |
11,256 |
$167K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,386 |
2,345 |
$120K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,014 |
767 |
$101K |
| D9920 |
|
360 |
334 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
158 |
152 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$1K |
| D1354 |
|
40 |
12 |
$535.00 |