| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
25,255 |
24,824 |
$724K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,157 |
1,597 |
$709K |
| D0120 |
Periodic oral evaluation - established patient |
30,349 |
29,838 |
$618K |
| D1208 |
Topical application of fluoride, excluding varnish |
28,964 |
28,468 |
$487K |
| D1110 |
Prophylaxis - adult |
7,859 |
7,712 |
$308K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,497 |
2,295 |
$298K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,364 |
1,440 |
$253K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,771 |
9,693 |
$246K |
| D1351 |
Sealant - per tooth |
7,505 |
2,131 |
$155K |
| D0220 |
Intraoral - periapical first radiographic image |
12,477 |
12,063 |
$142K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,090 |
1,288 |
$139K |
| D2140 |
|
2,464 |
1,529 |
$124K |
| D0274 |
Bitewings - four radiographic images |
3,684 |
3,607 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,553 |
3,453 |
$92K |
| D0272 |
Bitewings - two radiographic images |
4,532 |
4,469 |
$88K |
| D0240 |
|
4,651 |
3,998 |
$71K |
| D0330 |
Panoramic radiographic image |
1,475 |
1,427 |
$70K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,084 |
3,956 |
$55K |
| D9420 |
|
1,248 |
1,202 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
1,349 |
1,302 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
112 |
104 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
24 |
$2K |
| D7910 |
|
13 |
13 |
$1K |
| D9248 |
|
13 |
12 |
$1K |
| D0603 |
|
762 |
762 |
$20.00 |
| D0602 |
|
1,526 |
1,525 |
$5.00 |
| D1999 |
|
2,988 |
2,847 |
$0.00 |
| D0601 |
|
690 |
690 |
$0.00 |