| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
29,148 |
28,792 |
$1.54M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27,626 |
27,296 |
$788K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,852 |
1,216 |
$772K |
| D0330 |
Panoramic radiographic image |
8,642 |
8,525 |
$430K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,398 |
22,047 |
$327K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,522 |
2,375 |
$309K |
| D1351 |
Sealant - per tooth |
13,485 |
3,447 |
$285K |
| D1110 |
Prophylaxis - adult |
5,055 |
4,981 |
$268K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,597 |
1,490 |
$230K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,990 |
2,718 |
$216K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,080 |
2,574 |
$209K |
| D1206 |
Topical application of fluoride varnish |
11,349 |
11,279 |
$208K |
| D0272 |
Bitewings - two radiographic images |
9,737 |
9,593 |
$181K |
| D0120 |
Periodic oral evaluation - established patient |
6,430 |
6,347 |
$152K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,076 |
3,013 |
$117K |
| D0274 |
Bitewings - four radiographic images |
3,283 |
3,234 |
$99K |
| D9420 |
|
1,425 |
1,375 |
$92K |
| D2330 |
|
1,126 |
729 |
$59K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,515 |
1,495 |
$39K |
| D9110 |
|
374 |
365 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
562 |
543 |
$6K |
| D0270 |
|
323 |
319 |
$3K |
| D2332 |
|
31 |
26 |
$2K |
| D2331 |
|
29 |
25 |
$2K |
| D9248 |
|
12 |
12 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |