| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
60,828 |
60,826 |
$2.12M |
| D0120 |
Periodic oral evaluation - established patient |
73,106 |
73,098 |
$1.71M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,921 |
4,302 |
$1.64M |
| D1206 |
Topical application of fluoride varnish |
88,354 |
88,344 |
$1.45M |
| D1110 |
Prophylaxis - adult |
26,598 |
26,589 |
$1.33M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,596 |
8,874 |
$1.30M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,911 |
7,167 |
$836K |
| D1351 |
Sealant - per tooth |
23,132 |
7,164 |
$691K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,371 |
3,794 |
$614K |
| D0272 |
Bitewings - two radiographic images |
31,546 |
31,540 |
$600K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
18,463 |
17,750 |
$595K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,433 |
9,431 |
$389K |
| D9248 |
|
5,349 |
5,315 |
$372K |
| D0330 |
Panoramic radiographic image |
7,006 |
7,004 |
$355K |
| D0145 |
Oral evaluation for a patient under three years of age |
8,163 |
8,163 |
$352K |
| D0274 |
Bitewings - four radiographic images |
10,221 |
10,219 |
$280K |
| D0140 |
Limited oral evaluation - problem focused |
5,054 |
5,039 |
$194K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,400 |
947 |
$129K |
| D0240 |
|
6,482 |
6,395 |
$125K |
| D9222 |
|
930 |
930 |
$105K |
| D0220 |
Intraoral - periapical first radiographic image |
6,532 |
6,473 |
$84K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
594 |
491 |
$77K |
| D2330 |
|
261 |
169 |
$18K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
203 |
130 |
$17K |
| D2331 |
|
125 |
80 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
741 |
444 |
$7K |
| D2332 |
|
53 |
40 |
$6K |
| D9992 |
|
143 |
143 |
$4K |