| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
39,080 |
39,019 |
$3.03M |
| D1110 |
Prophylaxis - adult |
15,782 |
15,758 |
$1.64M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,319 |
7,552 |
$941K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14,250 |
3,470 |
$936K |
| D0330 |
Panoramic radiographic image |
6,245 |
6,235 |
$631K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,338 |
5,252 |
$393K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,339 |
4,331 |
$216K |
| D9420 |
|
1,648 |
1,633 |
$197K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,253 |
2,773 |
$166K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,692 |
2,679 |
$155K |
| D0140 |
Limited oral evaluation - problem focused |
2,466 |
2,437 |
$76K |
| D2934 |
|
110 |
38 |
$62K |
| D9248 |
|
227 |
223 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
50,261 |
50,200 |
$47K |
| D1351 |
Sealant - per tooth |
34,970 |
7,322 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
173 |
173 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
139 |
123 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16,178 |
15,672 |
$5K |
| D1206 |
Topical application of fluoride varnish |
28,104 |
28,054 |
$5K |
| D2332 |
|
45 |
26 |
$5K |
| D0274 |
Bitewings - four radiographic images |
12,410 |
12,389 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
51,935 |
51,670 |
$2K |
| D0272 |
Bitewings - two radiographic images |
31,307 |
31,254 |
$2K |
| D2330 |
|
87 |
49 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,583 |
703 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
30,138 |
30,099 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
69,095 |
47,748 |
$341.13 |
| D9986 |
|
716 |
713 |
$0.00 |
| D1999 |
|
8,104 |
8,057 |
$0.00 |
| D3230 |
|
151 |
51 |
$0.00 |