| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
48,835 |
48,827 |
$1.60M |
| D1206 |
Topical application of fluoride varnish |
39,692 |
39,670 |
$979K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,341 |
8,936 |
$895K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,309 |
4,984 |
$892K |
| D1351 |
Sealant - per tooth |
19,678 |
8,081 |
$886K |
| D0120 |
Periodic oral evaluation - established patient |
40,413 |
40,409 |
$884K |
| D0220 |
Intraoral - periapical first radiographic image |
46,307 |
46,103 |
$485K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,595 |
6,328 |
$401K |
| D1110 |
Prophylaxis - adult |
9,471 |
9,471 |
$390K |
| D0230 |
Intraoral - periapical each additional radiographic image |
40,468 |
40,409 |
$323K |
| D0272 |
Bitewings - two radiographic images |
23,894 |
23,891 |
$301K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,160 |
5,367 |
$299K |
| D0274 |
Bitewings - four radiographic images |
11,488 |
11,487 |
$244K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,953 |
18,949 |
$232K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,367 |
9,363 |
$218K |
| D9243 |
|
758 |
723 |
$155K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,442 |
1,299 |
$146K |
| D0330 |
Panoramic radiographic image |
4,137 |
4,134 |
$121K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,172 |
4,172 |
$103K |
| D9310 |
|
1,881 |
1,881 |
$90K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,064 |
902 |
$80K |
| D2335 |
|
729 |
274 |
$69K |
| D1354 |
|
2,813 |
1,217 |
$64K |
| D8660 |
|
1,777 |
1,773 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
6,075 |
6,040 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
3,499 |
3,475 |
$39K |
| D9239 |
|
726 |
724 |
$36K |
| D0340 |
|
894 |
893 |
$34K |
| D0273 |
|
1,459 |
1,458 |
$23K |
| D0470 |
|
788 |
786 |
$21K |
| D7111 |
|
723 |
661 |
$17K |
| D8670 |
Periodic orthodontic treatment visit |
40 |
40 |
$9K |
| D0350 |
|
863 |
860 |
$9K |
| D0270 |
|
345 |
344 |
$4K |
| D2330 |
|
100 |
66 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
109 |
103 |
$3K |
| D9610 |
|
218 |
217 |
$2K |
| D2332 |
|
17 |
12 |
$1K |
| D9430 |
|
123 |
122 |
$1K |
| D9110 |
|
58 |
58 |
$1K |
| D0603 |
|
390 |
390 |
$388.00 |
| D0601 |
|
212 |
212 |
$212.00 |
| D9920 |
|
78 |
77 |
$40.00 |