| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
19,088 |
17,465 |
$509K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,651 |
1,935 |
$509K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,510 |
2,577 |
$395K |
| D0120 |
Periodic oral evaluation - established patient |
19,326 |
17,537 |
$348K |
| D1999 |
|
12,767 |
11,651 |
$231K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,315 |
15,599 |
$225K |
| D0272 |
Bitewings - two radiographic images |
11,711 |
10,555 |
$192K |
| D1206 |
Topical application of fluoride varnish |
5,260 |
5,036 |
$146K |
| D0330 |
Panoramic radiographic image |
3,297 |
2,954 |
$144K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,755 |
5,935 |
$138K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,705 |
1,528 |
$136K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,051 |
1,163 |
$123K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,244 |
700 |
$89K |
| D0140 |
Limited oral evaluation - problem focused |
2,809 |
2,555 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,802 |
2,713 |
$67K |
| D0240 |
|
3,652 |
2,072 |
$61K |
| D1110 |
Prophylaxis - adult |
1,165 |
1,009 |
$35K |
| D1351 |
Sealant - per tooth |
1,464 |
463 |
$35K |
| D2932 |
|
308 |
81 |
$25K |
| D0145 |
Oral evaluation for a patient under three years of age |
552 |
539 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
983 |
896 |
$10K |
| D2330 |
|
124 |
65 |
$6K |
| D0274 |
Bitewings - four radiographic images |
189 |
138 |
$3K |
| D1510 |
|
15 |
13 |
$2K |
| D2331 |
|
18 |
13 |
$1K |
| D1354 |
|
49 |
15 |
$840.00 |
| D9248 |
|
592 |
557 |
$735.00 |