| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,441 |
5,367 |
$177K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,089 |
377 |
$137K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,593 |
1,081 |
$112K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,261 |
815 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
5,306 |
5,235 |
$103K |
| D9920 |
|
1,055 |
933 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,614 |
3,583 |
$71K |
| D1351 |
Sealant - per tooth |
2,219 |
1,054 |
$70K |
| D0274 |
Bitewings - four radiographic images |
2,201 |
2,177 |
$59K |
| D1206 |
Topical application of fluoride varnish |
2,706 |
2,657 |
$57K |
| D1355 |
|
1,188 |
357 |
$39K |
| D1110 |
Prophylaxis - adult |
759 |
755 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
825 |
817 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
301 |
168 |
$20K |
| D9630 |
|
854 |
821 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
405 |
373 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
320 |
311 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,088 |
1,051 |
$12K |
| D0330 |
Panoramic radiographic image |
233 |
230 |
$12K |
| D0272 |
Bitewings - two radiographic images |
577 |
572 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
848 |
397 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
107 |
37 |
$9K |
| D0240 |
|
617 |
326 |
$8K |
| D9310 |
|
89 |
89 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
191 |
181 |
$5K |
| D1354 |
|
859 |
259 |
$4K |
| D2330 |
|
35 |
24 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$2K |
| D9110 |
|
24 |
24 |
$1K |