| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
63,850 |
62,052 |
$2.00M |
| D0120 |
Periodic oral evaluation - established patient |
65,047 |
63,128 |
$1.46M |
| D1206 |
Topical application of fluoride varnish |
73,091 |
71,021 |
$1.43M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,361 |
3,681 |
$774K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,470 |
7,747 |
$730K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
20,188 |
18,756 |
$567K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,584 |
5,736 |
$432K |
| D1110 |
Prophylaxis - adult |
10,915 |
10,533 |
$426K |
| D0330 |
Panoramic radiographic image |
10,234 |
9,846 |
$417K |
| D0272 |
Bitewings - two radiographic images |
21,844 |
21,173 |
$363K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,521 |
3,730 |
$325K |
| D0230 |
Intraoral - periapical each additional radiographic image |
34,539 |
12,429 |
$300K |
| D0220 |
Intraoral - periapical first radiographic image |
25,440 |
24,507 |
$287K |
| D9248 |
|
2,568 |
2,389 |
$214K |
| D0274 |
Bitewings - four radiographic images |
7,633 |
7,352 |
$192K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,526 |
4,413 |
$125K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,113 |
4,990 |
$113K |
| D1351 |
Sealant - per tooth |
2,657 |
691 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
3,345 |
3,224 |
$72K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
427 |
255 |
$33K |
| D2330 |
|
39 |
27 |
$2K |
| D2331 |
|
19 |
14 |
$1K |