| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
23,140 |
22,744 |
$770K |
| D1206 |
Topical application of fluoride varnish |
29,397 |
28,866 |
$611K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,407 |
2,237 |
$492K |
| D1351 |
Sealant - per tooth |
13,784 |
3,625 |
$410K |
| D0120 |
Periodic oral evaluation - established patient |
12,745 |
12,482 |
$307K |
| D1110 |
Prophylaxis - adult |
6,327 |
6,204 |
$269K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,448 |
2,296 |
$252K |
| D0330 |
Panoramic radiographic image |
7,336 |
7,161 |
$242K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,646 |
1,605 |
$160K |
| D0272 |
Bitewings - two radiographic images |
9,065 |
8,883 |
$152K |
| D9248 |
|
1,857 |
1,726 |
$148K |
| D0274 |
Bitewings - four radiographic images |
5,320 |
5,213 |
$137K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,962 |
3,714 |
$113K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,876 |
3,773 |
$111K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,317 |
855 |
$107K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,688 |
1,256 |
$102K |
| D1353 |
|
2,225 |
628 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
4,214 |
4,052 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
818 |
805 |
$38K |
| D1510 |
|
234 |
193 |
$36K |
| D2929 |
|
274 |
86 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
830 |
782 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,679 |
664 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
576 |
570 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
238 |
233 |
$4K |
| D4355 |
|
56 |
55 |
$3K |
| D9996 |
|
105 |
92 |
$0.00 |
| D1330 |
|
314 |
299 |
$0.00 |