| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
34,013 |
33,980 |
$1.11M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,818 |
7,550 |
$843K |
| D0120 |
Periodic oral evaluation - established patient |
36,104 |
36,065 |
$827K |
| D1351 |
Sealant - per tooth |
19,258 |
5,997 |
$706K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15,552 |
7,560 |
$634K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,319 |
2,828 |
$623K |
| D0274 |
Bitewings - four radiographic images |
26,270 |
26,238 |
$618K |
| D1208 |
Topical application of fluoride, excluding varnish |
41,502 |
41,461 |
$464K |
| D2335 |
|
3,495 |
1,255 |
$398K |
| D1110 |
Prophylaxis - adult |
8,303 |
8,295 |
$350K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,923 |
4,451 |
$342K |
| D0220 |
Intraoral - periapical first radiographic image |
29,160 |
28,965 |
$316K |
| D1354 |
|
7,447 |
2,120 |
$252K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,823 |
6,822 |
$157K |
| D1206 |
Topical application of fluoride varnish |
4,481 |
4,480 |
$119K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,357 |
1,030 |
$97K |
| D0140 |
Limited oral evaluation - problem focused |
6,525 |
6,509 |
$79K |
| D0272 |
Bitewings - two radiographic images |
4,694 |
4,686 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,249 |
10,232 |
$62K |
| D0330 |
Panoramic radiographic image |
2,353 |
2,349 |
$60K |
| D2330 |
|
1,264 |
863 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,052 |
1,019 |
$39K |
| D2331 |
|
365 |
267 |
$25K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
184 |
125 |
$13K |
| D2332 |
|
155 |
110 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
469 |
469 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
85 |
50 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
338 |
334 |
$5K |
| D2140 |
|
95 |
53 |
$4K |
| D2920 |
|
25 |
24 |
$905.88 |
| D9310 |
|
13 |
13 |
$687.97 |
| D7111 |
|
19 |
14 |
$578.54 |
| D9110 |
|
31 |
31 |
$344.32 |
| D0270 |
|
13 |
13 |
$160.55 |
| D9997 |
|
27 |
27 |
$60.00 |
| D1330 |
|
34 |
34 |
$0.00 |