| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
27,102 |
27,098 |
$939K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,778 |
8,123 |
$871K |
| D0120 |
Periodic oral evaluation - established patient |
28,136 |
28,131 |
$661K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,921 |
2,513 |
$456K |
| D0272 |
Bitewings - two radiographic images |
22,616 |
22,597 |
$311K |
| D1206 |
Topical application of fluoride varnish |
12,572 |
12,567 |
$292K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,696 |
4,048 |
$266K |
| D1351 |
Sealant - per tooth |
4,677 |
2,718 |
$256K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,470 |
18,465 |
$233K |
| D0220 |
Intraoral - periapical first radiographic image |
20,591 |
20,530 |
$225K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
471 |
469 |
$200K |
| D1110 |
Prophylaxis - adult |
4,232 |
4,231 |
$196K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,419 |
1,316 |
$124K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,798 |
14,758 |
$90K |
| D0274 |
Bitewings - four radiographic images |
3,468 |
3,467 |
$81K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,737 |
1,493 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,390 |
2,390 |
$55K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
434 |
405 |
$51K |
| D2332 |
|
371 |
331 |
$44K |
| D9222 |
|
481 |
479 |
$27K |
| D2335 |
|
84 |
74 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,428 |
1,307 |
$14K |
| D9310 |
|
182 |
182 |
$11K |
| D9995 |
|
658 |
658 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
954 |
950 |
$10K |
| D2330 |
|
149 |
129 |
$9K |
| D2331 |
|
65 |
64 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
80 |
80 |
$2K |
| D9110 |
|
80 |
79 |
$2K |
| D0270 |
|
131 |
131 |
$1K |
| D1510 |
|
12 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
93 |
93 |
$643.63 |
| D0330 |
Panoramic radiographic image |
21 |
21 |
$478.72 |
| D7111 |
|
13 |
13 |
$392.70 |
| D0601 |
|
3,626 |
3,625 |
$0.00 |
| D1310 |
|
10,250 |
10,244 |
$0.00 |
| D0603 |
|
11,773 |
11,770 |
$0.00 |
| D1330 |
|
19,146 |
19,139 |
$0.00 |
| D0602 |
|
2,179 |
2,179 |
$0.00 |
| D1999 |
|
8,732 |
8,208 |
$0.00 |