| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
19,954 |
19,434 |
$456K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,033 |
1,787 |
$297K |
| D0120 |
Periodic oral evaluation - established patient |
15,614 |
15,255 |
$282K |
| D1206 |
Topical application of fluoride varnish |
20,042 |
19,516 |
$207K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,510 |
1,988 |
$140K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,816 |
1,772 |
$133K |
| D1351 |
Sealant - per tooth |
7,695 |
2,523 |
$127K |
| D0272 |
Bitewings - two radiographic images |
10,602 |
10,331 |
$117K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,083 |
1,144 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,950 |
3,852 |
$86K |
| D1354 |
|
12,704 |
3,328 |
$86K |
| D0603 |
|
16,829 |
16,474 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
3,084 |
2,933 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,772 |
3,545 |
$57K |
| D0240 |
|
6,317 |
3,329 |
$54K |
| D0330 |
Panoramic radiographic image |
1,782 |
1,751 |
$48K |
| D1110 |
Prophylaxis - adult |
1,063 |
1,047 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
4,995 |
4,805 |
$33K |
| D8660 |
|
243 |
230 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,092 |
2,227 |
$22K |
| D2929 |
|
94 |
17 |
$21K |
| D9420 |
|
125 |
125 |
$18K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
203 |
141 |
$14K |
| D0274 |
Bitewings - four radiographic images |
405 |
395 |
$9K |
| D0601 |
|
2,103 |
1,997 |
$7K |
| D0602 |
|
1,360 |
1,302 |
$4K |
| D2330 |
|
89 |
55 |
$4K |
| D9920 |
|
5,567 |
5,366 |
$3K |
| D1999 |
|
500 |
467 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
556 |
535 |
$758.47 |
| D0270 |
|
68 |
67 |
$686.70 |
| D1320 |
|
757 |
749 |
$220.00 |
| D1330 |
|
20,270 |
19,791 |
$150.00 |
| D1310 |
|
20,199 |
19,720 |
$150.00 |
| D1510 |
|
15 |
12 |
$0.00 |
| D9986 |
|
706 |
679 |
$0.00 |
| D9971 |
|
92 |
44 |
$0.00 |
| D0470 |
|
243 |
230 |
$0.00 |
| D3120 |
|
21 |
13 |
$0.00 |
| D9995 |
|
20 |
19 |
$0.00 |