| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
30,253 |
29,555 |
$862K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,689 |
2,443 |
$709K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,658 |
4,811 |
$658K |
| D0120 |
Periodic oral evaluation - established patient |
26,482 |
25,993 |
$646K |
| D1351 |
Sealant - per tooth |
17,360 |
4,741 |
$318K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,537 |
18,150 |
$270K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,504 |
3,205 |
$269K |
| D9999 |
Unspecified adjunctive procedure, by report |
8,505 |
8,300 |
$262K |
| D1206 |
Topical application of fluoride varnish |
11,275 |
11,010 |
$256K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,723 |
6,485 |
$222K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,735 |
2,516 |
$202K |
| D0140 |
Limited oral evaluation - problem focused |
7,173 |
6,954 |
$169K |
| D1110 |
Prophylaxis - adult |
3,110 |
3,057 |
$166K |
| D0220 |
Intraoral - periapical first radiographic image |
21,763 |
20,694 |
$137K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,763 |
6,410 |
$117K |
| D0272 |
Bitewings - two radiographic images |
14,020 |
13,683 |
$111K |
| D0330 |
Panoramic radiographic image |
2,628 |
2,576 |
$100K |
| D9420 |
|
239 |
239 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,222 |
17,610 |
$39K |
| D1999 |
|
3,059 |
2,919 |
$39K |
| D1510 |
|
76 |
57 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
413 |
247 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
163 |
117 |
$15K |
| D2330 |
|
242 |
146 |
$12K |
| D0274 |
Bitewings - four radiographic images |
980 |
962 |
$12K |
| D2934 |
|
56 |
14 |
$11K |
| D1354 |
|
2,874 |
839 |
$9K |
| D2940 |
|
23 |
13 |
$598.91 |