| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
49,345 |
48,315 |
$1.66M |
| D0120 |
Periodic oral evaluation - established patient |
51,585 |
50,496 |
$1.24M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,212 |
4,124 |
$1.10M |
| D1208 |
Topical application of fluoride, excluding varnish |
47,494 |
46,543 |
$987K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,061 |
5,350 |
$719K |
| D9248 |
|
5,826 |
5,162 |
$444K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,488 |
2,691 |
$436K |
| D0330 |
Panoramic radiographic image |
8,635 |
8,445 |
$372K |
| D0272 |
Bitewings - two radiographic images |
20,519 |
20,068 |
$362K |
| D1110 |
Prophylaxis - adult |
7,989 |
7,807 |
$339K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,325 |
2,721 |
$311K |
| D1351 |
Sealant - per tooth |
8,627 |
2,803 |
$252K |
| D1206 |
Topical application of fluoride varnish |
9,863 |
9,611 |
$198K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,007 |
4,874 |
$145K |
| D0274 |
Bitewings - four radiographic images |
5,268 |
5,129 |
$142K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,724 |
1,382 |
$141K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,078 |
1,551 |
$124K |
| D0220 |
Intraoral - periapical first radiographic image |
10,368 |
9,949 |
$124K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,899 |
3,714 |
$109K |
| D1510 |
|
757 |
583 |
$108K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,603 |
5,249 |
$52K |
| D2933 |
|
285 |
110 |
$43K |
| D1354 |
|
6,768 |
2,239 |
$39K |
| D9110 |
|
821 |
798 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,903 |
1,792 |
$37K |
| D0270 |
|
345 |
339 |
$3K |
| D2330 |
|
35 |
27 |
$2K |
| D2332 |
|
15 |
12 |
$1K |