| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
15,292 |
15,292 |
$771K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,089 |
3,452 |
$638K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,295 |
4,489 |
$604K |
| D1120 |
Prophylaxis - child |
16,338 |
16,338 |
$571K |
| D0120 |
Periodic oral evaluation - established patient |
22,799 |
22,799 |
$531K |
| D1206 |
Topical application of fluoride varnish |
30,698 |
30,698 |
$503K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,582 |
1,406 |
$453K |
| D0274 |
Bitewings - four radiographic images |
16,625 |
16,625 |
$444K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,366 |
10,054 |
$338K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,129 |
8,129 |
$330K |
| D1351 |
Sealant - per tooth |
10,959 |
4,204 |
$330K |
| D0330 |
Panoramic radiographic image |
5,719 |
5,719 |
$281K |
| D0272 |
Bitewings - two radiographic images |
10,371 |
10,371 |
$193K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,172 |
673 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
6,676 |
6,636 |
$87K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
628 |
391 |
$83K |
| D7240 |
Removal of impacted tooth - completely bony |
289 |
82 |
$81K |
| D0140 |
Limited oral evaluation - problem focused |
1,157 |
1,149 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,778 |
2,604 |
$32K |
| D2160 |
|
306 |
194 |
$28K |
| D0145 |
Oral evaluation for a patient under three years of age |
649 |
649 |
$27K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
121 |
117 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
112 |
67 |
$11K |
| D9222 |
|
107 |
107 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
60 |
38 |
$5K |
| D0240 |
|
280 |
166 |
$5K |
| D2140 |
|
69 |
45 |
$4K |
| D7111 |
|
58 |
42 |
$4K |
| D9310 |
|
17 |
17 |
$1K |