| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
41,299 |
39,793 |
$1.29M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,386 |
2,867 |
$1.11M |
| D1206 |
Topical application of fluoride varnish |
41,717 |
40,222 |
$825K |
| D0120 |
Periodic oral evaluation - established patient |
34,112 |
32,889 |
$804K |
| D9248 |
|
6,054 |
5,784 |
$443K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,282 |
2,315 |
$291K |
| D0272 |
Bitewings - two radiographic images |
16,257 |
15,688 |
$279K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,188 |
1,105 |
$250K |
| D0220 |
Intraoral - periapical first radiographic image |
16,552 |
15,530 |
$190K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,162 |
1,612 |
$168K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,765 |
6,510 |
$142K |
| D1351 |
Sealant - per tooth |
5,132 |
1,712 |
$119K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,899 |
4,686 |
$111K |
| D2929 |
|
744 |
193 |
$85K |
| D0330 |
Panoramic radiographic image |
1,596 |
1,499 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,816 |
1,748 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
848 |
631 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,052 |
992 |
$29K |
| D1110 |
Prophylaxis - adult |
703 |
647 |
$29K |
| D9110 |
|
175 |
171 |
$8K |
| D0274 |
Bitewings - four radiographic images |
171 |
166 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
55 |
50 |
$549.40 |
| D9420 |
|
808 |
778 |
$0.00 |