| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
29,384 |
29,380 |
$848K |
| D0120 |
Periodic oral evaluation - established patient |
22,627 |
22,624 |
$641K |
| D1206 |
Topical application of fluoride varnish |
30,025 |
30,023 |
$458K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,284 |
2,053 |
$442K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,824 |
3,700 |
$426K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,755 |
6,438 |
$374K |
| D0272 |
Bitewings - two radiographic images |
16,869 |
16,867 |
$319K |
| D0220 |
Intraoral - periapical first radiographic image |
26,298 |
26,244 |
$310K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,026 |
17,226 |
$186K |
| D0240 |
|
8,536 |
8,427 |
$185K |
| D0274 |
Bitewings - four radiographic images |
5,531 |
5,531 |
$175K |
| D0330 |
Panoramic radiographic image |
2,986 |
2,986 |
$158K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,085 |
1,223 |
$131K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,939 |
1,122 |
$93K |
| D1110 |
Prophylaxis - adult |
2,254 |
2,254 |
$92K |
| D1351 |
Sealant - per tooth |
2,967 |
1,026 |
$84K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,193 |
681 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,458 |
1,458 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
700 |
689 |
$21K |
| D7240 |
Removal of impacted tooth - completely bony |
30 |
12 |
$10K |
| D1354 |
|
938 |
234 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
76 |
51 |
$4K |
| D9310 |
|
57 |
57 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
826 |
826 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
101 |
101 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
43 |
43 |
$2K |