| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
56,468 |
56,122 |
$2.29M |
| D0120 |
Periodic oral evaluation - established patient |
33,452 |
33,192 |
$2.16M |
| D1310 |
|
27,604 |
27,464 |
$1.24M |
| D1206 |
Topical application of fluoride varnish |
55,593 |
55,260 |
$909K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,916 |
11,877 |
$794K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,879 |
7,466 |
$753K |
| D9993 |
|
12,228 |
12,220 |
$745K |
| D0230 |
Intraoral - periapical each additional radiographic image |
177,095 |
44,662 |
$731K |
| D1351 |
Sealant - per tooth |
25,191 |
8,156 |
$719K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,866 |
10,538 |
$469K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,034 |
5,010 |
$336K |
| D0272 |
Bitewings - two radiographic images |
26,645 |
26,469 |
$304K |
| D0603 |
|
20,516 |
20,416 |
$295K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,472 |
3,396 |
$232K |
| D0274 |
Bitewings - four radiographic images |
9,708 |
9,632 |
$201K |
| D0350 |
|
18,132 |
11,877 |
$190K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,129 |
2,275 |
$174K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,735 |
1,344 |
$134K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,060 |
749 |
$123K |
| D0220 |
Intraoral - periapical first radiographic image |
8,223 |
8,139 |
$95K |
| D9430 |
|
2,605 |
2,543 |
$82K |
| D0601 |
|
5,115 |
5,082 |
$75K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
633 |
451 |
$61K |
| D0330 |
Panoramic radiographic image |
1,807 |
1,805 |
$52K |
| D0602 |
|
1,645 |
1,644 |
$24K |
| D1354 |
|
1,936 |
737 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
146 |
146 |
$7K |
| D2330 |
|
75 |
41 |
$6K |
| D1510 |
|
20 |
18 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
43 |
43 |
$344.00 |
| D0270 |
|
13 |
12 |
$65.00 |