| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
19,688 |
19,501 |
$550K |
| D0120 |
Periodic oral evaluation - established patient |
26,800 |
26,500 |
$498K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,049 |
4,005 |
$475K |
| D1208 |
Topical application of fluoride, excluding varnish |
27,077 |
26,777 |
$392K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,820 |
3,778 |
$368K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,690 |
1,646 |
$359K |
| D1999 |
|
18,823 |
17,545 |
$356K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,149 |
2,845 |
$280K |
| D0272 |
Bitewings - two radiographic images |
15,932 |
15,685 |
$279K |
| D1110 |
Prophylaxis - adult |
7,278 |
7,163 |
$263K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,546 |
10,662 |
$245K |
| D0330 |
Panoramic radiographic image |
4,925 |
4,864 |
$236K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,276 |
1,240 |
$170K |
| D1351 |
Sealant - per tooth |
4,393 |
1,266 |
$107K |
| D0220 |
Intraoral - periapical first radiographic image |
8,038 |
7,926 |
$89K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,745 |
7,688 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,823 |
2,732 |
$69K |
| D1206 |
Topical application of fluoride varnish |
2,485 |
2,408 |
$51K |
| D1354 |
|
1,573 |
514 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
823 |
795 |
$23K |
| D0274 |
Bitewings - four radiographic images |
931 |
919 |
$22K |
| D0240 |
|
1,188 |
979 |
$18K |
| D2330 |
|
271 |
173 |
$15K |
| D2332 |
|
180 |
109 |
$13K |
| D3120 |
|
14 |
12 |
$184.80 |