| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
40,457 |
38,938 |
$1.30M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,880 |
4,975 |
$1.23M |
| D0120 |
Periodic oral evaluation - established patient |
41,070 |
39,386 |
$951K |
| D1208 |
Topical application of fluoride, excluding varnish |
37,462 |
36,039 |
$739K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,510 |
5,469 |
$595K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,953 |
13,011 |
$385K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,653 |
3,436 |
$361K |
| D0272 |
Bitewings - two radiographic images |
20,335 |
19,492 |
$338K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,268 |
2,199 |
$317K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,266 |
3,539 |
$314K |
| D1351 |
Sealant - per tooth |
11,106 |
3,493 |
$307K |
| D1110 |
Prophylaxis - adult |
5,865 |
5,576 |
$234K |
| D0330 |
Panoramic radiographic image |
5,174 |
5,000 |
$208K |
| D1206 |
Topical application of fluoride varnish |
8,014 |
7,698 |
$156K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,084 |
3,911 |
$112K |
| D0220 |
Intraoral - periapical first radiographic image |
8,931 |
8,514 |
$105K |
| D2390 |
|
652 |
179 |
$95K |
| D0140 |
Limited oral evaluation - problem focused |
3,897 |
3,646 |
$79K |
| D9248 |
|
851 |
727 |
$60K |
| D2330 |
|
706 |
362 |
$41K |
| D7962 |
|
252 |
151 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
360 |
306 |
$30K |
| D2332 |
|
279 |
153 |
$21K |
| D1354 |
|
3,306 |
689 |
$20K |
| D0274 |
Bitewings - four radiographic images |
481 |
465 |
$13K |
| D2335 |
|
148 |
110 |
$12K |
| D1510 |
|
85 |
68 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
357 |
286 |
$3K |
| D2331 |
|
15 |
13 |
$989.56 |
| D7961 |
|
49 |
18 |
$0.00 |
| D9996 |
|
111 |
111 |
$0.00 |