| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
15,690 |
15,283 |
$519K |
| D0120 |
Periodic oral evaluation - established patient |
20,312 |
19,788 |
$482K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,446 |
18,861 |
$386K |
| D1110 |
Prophylaxis - adult |
7,269 |
7,070 |
$303K |
| D1351 |
Sealant - per tooth |
9,988 |
3,869 |
$290K |
| D0210 |
Intraoral - complete series of radiographic images |
4,372 |
4,233 |
$247K |
| D1353 |
|
8,920 |
3,143 |
$227K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,856 |
1,597 |
$206K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,095 |
1,393 |
$186K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,567 |
781 |
$169K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,599 |
1,427 |
$157K |
| D0274 |
Bitewings - four radiographic images |
5,921 |
5,773 |
$155K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
318 |
220 |
$118K |
| D1206 |
Topical application of fluoride varnish |
4,445 |
4,357 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,304 |
3,183 |
$89K |
| D0272 |
Bitewings - two radiographic images |
4,141 |
4,049 |
$71K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,047 |
1,974 |
$58K |
| D4342 |
|
1,189 |
287 |
$38K |
| D1354 |
|
4,325 |
933 |
$35K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
68 |
51 |
$33K |
| D0330 |
Panoramic radiographic image |
651 |
628 |
$28K |
| D2721 |
|
50 |
27 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
994 |
945 |
$20K |
| D4355 |
|
167 |
149 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
926 |
836 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
105 |
65 |
$9K |
| D4910 |
|
94 |
85 |
$6K |
| D3320 |
|
16 |
12 |
$6K |
| D2950 |
|
18 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
36 |
29 |
$136.90 |