| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
41,366 |
41,080 |
$1.62M |
| D0120 |
Periodic oral evaluation - established patient |
40,043 |
39,773 |
$974K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,209 |
9,701 |
$876K |
| D1208 |
Topical application of fluoride, excluding varnish |
43,152 |
42,869 |
$853K |
| D1351 |
Sealant - per tooth |
35,982 |
10,589 |
$791K |
| D9248 |
|
6,651 |
5,484 |
$776K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,303 |
3,668 |
$610K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,135 |
6,175 |
$441K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,919 |
5,227 |
$435K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,426 |
3,245 |
$309K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,086 |
8,039 |
$273K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17,920 |
16,292 |
$268K |
| D0272 |
Bitewings - two radiographic images |
14,853 |
14,677 |
$147K |
| D1110 |
Prophylaxis - adult |
3,347 |
3,326 |
$130K |
| D0140 |
Limited oral evaluation - problem focused |
3,270 |
3,224 |
$120K |
| D0240 |
|
11,622 |
6,903 |
$120K |
| D0602 |
|
15,693 |
15,576 |
$110K |
| D2933 |
|
926 |
409 |
$100K |
| D0603 |
|
13,366 |
13,254 |
$97K |
| D9420 |
|
298 |
294 |
$81K |
| D0274 |
Bitewings - four radiographic images |
5,762 |
5,734 |
$71K |
| D0330 |
Panoramic radiographic image |
2,042 |
2,020 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,908 |
6,685 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
9,429 |
9,260 |
$48K |
| D0601 |
|
4,337 |
4,325 |
$35K |
| D2331 |
|
537 |
366 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
575 |
569 |
$27K |
| D1510 |
|
187 |
142 |
$14K |
| D3230 |
|
87 |
47 |
$9K |
| D2332 |
|
127 |
78 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
85 |
79 |
$4K |
| D1206 |
Topical application of fluoride varnish |
356 |
354 |
$3K |
| D2330 |
|
40 |
26 |
$2K |
| D9920 |
|
701 |
493 |
$557.00 |
| D0191 |
|
22 |
22 |
$290.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
154 |
152 |
$111.55 |
| D0190 |
|
15 |
15 |
$75.00 |