| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
30,343 |
29,923 |
$1.31M |
| D0120 |
Periodic oral evaluation - established patient |
32,328 |
31,893 |
$947K |
| D1206 |
Topical application of fluoride varnish |
35,613 |
35,136 |
$881K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,827 |
2,975 |
$708K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,141 |
1,225 |
$694K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,413 |
1,628 |
$406K |
| D1110 |
Prophylaxis - adult |
4,946 |
4,878 |
$291K |
| D9248 |
|
1,450 |
1,435 |
$267K |
| D0272 |
Bitewings - two radiographic images |
12,885 |
12,703 |
$195K |
| D1351 |
Sealant - per tooth |
5,672 |
1,341 |
$192K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,749 |
1,185 |
$164K |
| D0330 |
Panoramic radiographic image |
3,359 |
3,313 |
$142K |
| D0274 |
Bitewings - four radiographic images |
4,958 |
4,884 |
$110K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,898 |
1,867 |
$100K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,073 |
4,927 |
$92K |
| D0140 |
Limited oral evaluation - problem focused |
994 |
987 |
$44K |
| D3120 |
|
1,212 |
797 |
$42K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
492 |
254 |
$37K |
| D0240 |
|
2,627 |
2,586 |
$36K |
| D9310 |
|
562 |
561 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,577 |
2,535 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
892 |
874 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
244 |
237 |
$10K |
| D9420 |
|
623 |
623 |
$9K |
| D1510 |
|
63 |
41 |
$6K |