| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
54,426 |
54,400 |
$2.25M |
| D0120 |
Periodic oral evaluation - established patient |
56,831 |
56,799 |
$1.54M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,938 |
12,120 |
$1.45M |
| D1351 |
Sealant - per tooth |
29,949 |
10,343 |
$1.43M |
| D1206 |
Topical application of fluoride varnish |
37,002 |
36,955 |
$1.11M |
| D1110 |
Prophylaxis - adult |
12,659 |
12,653 |
$677K |
| D0272 |
Bitewings - two radiographic images |
40,342 |
40,322 |
$661K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,922 |
3,349 |
$639K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,618 |
5,899 |
$423K |
| D1208 |
Topical application of fluoride, excluding varnish |
29,792 |
29,776 |
$385K |
| D0274 |
Bitewings - four radiographic images |
12,663 |
12,657 |
$336K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,986 |
9,982 |
$309K |
| D0220 |
Intraoral - periapical first radiographic image |
23,305 |
23,217 |
$309K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,797 |
3,659 |
$298K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,825 |
12,221 |
$127K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
849 |
725 |
$84K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
691 |
495 |
$70K |
| D9995 |
|
1,979 |
1,977 |
$49K |
| D2335 |
|
202 |
61 |
$33K |
| D9110 |
|
1,208 |
1,199 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,781 |
1,643 |
$27K |
| D1354 |
|
1,700 |
670 |
$26K |
| D9999 |
Unspecified adjunctive procedure, by report |
431 |
431 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
630 |
630 |
$10K |
| D9310 |
|
119 |
119 |
$9K |
| D2332 |
|
79 |
60 |
$9K |
| D7111 |
|
163 |
138 |
$8K |
| D0603 |
|
22,289 |
22,274 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
246 |
246 |
$8K |
| D1353 |
|
354 |
92 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
153 |
153 |
$4K |
| D0602 |
|
11,966 |
11,955 |
$4K |
| D2330 |
|
45 |
36 |
$3K |
| D0601 |
|
2,113 |
2,111 |
$3K |
| D1510 |
|
13 |
13 |
$2K |
| D1330 |
|
40,978 |
40,949 |
$825.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$465.41 |
| D9430 |
|
12 |
12 |
$257.25 |
| D1310 |
|
4,541 |
4,534 |
$0.00 |
| D1999 |
|
23,423 |
22,886 |
$0.00 |
| D9986 |
|
12 |
12 |
$0.00 |