| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,382 |
11,120 |
$575K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,958 |
1,225 |
$514K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,190 |
1,548 |
$206K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,014 |
5,855 |
$161K |
| D1206 |
Topical application of fluoride varnish |
9,853 |
9,650 |
$145K |
| D0120 |
Periodic oral evaluation - established patient |
6,861 |
6,708 |
$136K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,620 |
1,263 |
$121K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,900 |
1,101 |
$97K |
| D0272 |
Bitewings - two radiographic images |
6,689 |
6,514 |
$92K |
| D1351 |
Sealant - per tooth |
4,387 |
1,191 |
$86K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,155 |
3,898 |
$84K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,525 |
2,373 |
$81K |
| D0330 |
Panoramic radiographic image |
2,039 |
1,990 |
$80K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,146 |
518 |
$69K |
| D1110 |
Prophylaxis - adult |
1,224 |
1,185 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
5,545 |
5,200 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,658 |
1,577 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,502 |
2,412 |
$36K |
| D9420 |
|
655 |
573 |
$29K |
| D0274 |
Bitewings - four radiographic images |
904 |
888 |
$25K |
| D2932 |
|
87 |
27 |
$9K |
| D9248 |
|
87 |
80 |
$8K |
| D2330 |
|
76 |
24 |
$2K |
| D2332 |
|
16 |
12 |
$1K |
| D2331 |
|
16 |
12 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$1K |
| D0707 |
|
19 |
19 |
$59.96 |
| D9987 |
|
56 |
53 |
$0.00 |
| D9986 |
|
268 |
260 |
$0.00 |
| D9310 |
|
42 |
35 |
$0.00 |