| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
123,317 |
116,502 |
$3.74M |
| D0120 |
Periodic oral evaluation - established patient |
156,325 |
147,977 |
$3.44M |
| D1351 |
Sealant - per tooth |
135,693 |
17,063 |
$3.26M |
| D1206 |
Topical application of fluoride varnish |
164,240 |
155,082 |
$2.93M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
26,634 |
8,997 |
$2.83M |
| D1110 |
Prophylaxis - adult |
42,392 |
40,032 |
$1.78M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22,897 |
14,231 |
$1.65M |
| D0274 |
Bitewings - four radiographic images |
52,780 |
49,628 |
$1.58M |
| D0272 |
Bitewings - two radiographic images |
72,540 |
68,445 |
$1.49M |
| D7140 |
Extraction, erupted tooth or exposed root |
18,478 |
9,074 |
$1.36M |
| D0230 |
Intraoral - periapical each additional radiographic image |
122,365 |
41,154 |
$1.26M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17,283 |
11,295 |
$1.16M |
| D0330 |
Panoramic radiographic image |
30,157 |
27,693 |
$1.00M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
39,539 |
32,757 |
$977K |
| D0220 |
Intraoral - periapical first radiographic image |
61,090 |
56,238 |
$745K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15,383 |
14,246 |
$450K |
| D0140 |
Limited oral evaluation - problem focused |
10,720 |
9,902 |
$305K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,164 |
1,225 |
$167K |
| D2330 |
|
106 |
66 |
$6K |
| D2934 |
|
91 |
15 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
48 |
40 |
$4K |
| D1510 |
|
17 |
12 |
$2K |
| D2332 |
|
27 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
73 |
73 |
$2K |
| D2331 |
|
16 |
12 |
$1K |
| D1999 |
|
23,845 |
21,069 |
$0.00 |
| D3120 |
|
34 |
25 |
$0.00 |
| D9220 |
|
14 |
13 |
$0.00 |