| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
25,894 |
25,582 |
$941K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,113 |
2,505 |
$832K |
| D0120 |
Periodic oral evaluation - established patient |
22,012 |
21,706 |
$622K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,017 |
3,324 |
$563K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,555 |
17,304 |
$360K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,060 |
2,048 |
$312K |
| D0272 |
Bitewings - two radiographic images |
15,877 |
15,585 |
$308K |
| D1206 |
Topical application of fluoride varnish |
11,338 |
11,221 |
$290K |
| D0330 |
Panoramic radiographic image |
4,859 |
4,791 |
$258K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,411 |
6,564 |
$257K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,160 |
4,076 |
$199K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,772 |
3,745 |
$184K |
| D1110 |
Prophylaxis - adult |
3,694 |
3,614 |
$178K |
| D0220 |
Intraoral - periapical first radiographic image |
12,207 |
11,759 |
$171K |
| D0210 |
Intraoral - complete series of radiographic images |
1,636 |
1,604 |
$93K |
| D9248 |
|
1,391 |
1,043 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,441 |
6,395 |
$82K |
| D1351 |
Sealant - per tooth |
1,640 |
493 |
$48K |
| D9420 |
|
641 |
468 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
2,518 |
2,457 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
272 |
166 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
138 |
82 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
115 |
61 |
$11K |
| D2140 |
|
101 |
66 |
$8K |
| D7962 |
|
67 |
40 |
$5K |
| D7961 |
|
43 |
24 |
$211.21 |
| D0350 |
|
534 |
343 |
$137.10 |