| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,266 |
9,254 |
$411K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,004 |
2,332 |
$344K |
| D1351 |
Sealant - per tooth |
15,966 |
4,000 |
$310K |
| D1206 |
Topical application of fluoride varnish |
9,868 |
9,856 |
$306K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,986 |
773 |
$296K |
| D0120 |
Periodic oral evaluation - established patient |
8,388 |
8,380 |
$208K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,462 |
1,959 |
$186K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,172 |
4,129 |
$103K |
| D9999 |
Unspecified adjunctive procedure, by report |
227 |
214 |
$82K |
| D1353 |
|
8,078 |
1,929 |
$75K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,042 |
586 |
$61K |
| D0272 |
Bitewings - two radiographic images |
5,335 |
5,325 |
$52K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
617 |
276 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
6,796 |
6,779 |
$33K |
| D0603 |
|
3,590 |
3,587 |
$31K |
| D2932 |
|
202 |
56 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,984 |
1,977 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
502 |
499 |
$22K |
| D0601 |
|
2,285 |
2,278 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,930 |
5,916 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
725 |
724 |
$18K |
| D9920 |
|
660 |
655 |
$17K |
| D1110 |
Prophylaxis - adult |
355 |
355 |
$15K |
| D7111 |
|
225 |
153 |
$10K |
| D2330 |
|
121 |
57 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
244 |
244 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
64 |
43 |
$5K |
| D0602 |
|
444 |
444 |
$4K |
| D2332 |
|
15 |
12 |
$1K |
| D9420 |
|
189 |
173 |
$15.00 |