| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
17,065 |
16,143 |
$718K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,217 |
13,313 |
$394K |
| D0120 |
Periodic oral evaluation - established patient |
16,358 |
15,460 |
$336K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,663 |
1,805 |
$226K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,943 |
1,398 |
$208K |
| D1206 |
Topical application of fluoride varnish |
5,464 |
5,283 |
$189K |
| D1110 |
Prophylaxis - adult |
2,706 |
2,556 |
$165K |
| D0272 |
Bitewings - two radiographic images |
6,221 |
5,932 |
$149K |
| D0330 |
Panoramic radiographic image |
2,242 |
2,155 |
$135K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,628 |
1,199 |
$125K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
417 |
326 |
$115K |
| D0240 |
|
2,335 |
2,223 |
$110K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,688 |
2,551 |
$94K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,117 |
802 |
$93K |
| D0274 |
Bitewings - four radiographic images |
1,775 |
1,683 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,775 |
1,645 |
$59K |
| D1310 |
|
1,707 |
1,425 |
$58K |
| D1351 |
Sealant - per tooth |
1,738 |
495 |
$57K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
381 |
293 |
$51K |
| D1330 |
|
1,705 |
1,423 |
$51K |
| D9920 |
|
845 |
801 |
$21K |
| D2140 |
|
253 |
198 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
478 |
428 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
218 |
194 |
$6K |
| D0180 |
|
131 |
121 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$2K |
| D9110 |
|
25 |
25 |
$1K |
| D2330 |
|
14 |
12 |
$1K |