| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,572 |
7,460 |
$237K |
| D0272 |
Bitewings - two radiographic images |
7,047 |
6,943 |
$175K |
| D1110 |
Prophylaxis - adult |
3,182 |
3,133 |
$139K |
| D0210 |
Intraoral - complete series of radiographic images |
1,271 |
1,257 |
$131K |
| D1351 |
Sealant - per tooth |
6,453 |
1,583 |
$83K |
| D1330 |
|
10,742 |
10,586 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,540 |
10,384 |
$45K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
627 |
396 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,416 |
1,319 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,387 |
1,367 |
$28K |
| D0240 |
|
435 |
416 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
571 |
394 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
9,320 |
9,179 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
151 |
96 |
$11K |
| D2140 |
|
269 |
203 |
$11K |
| D0330 |
Panoramic radiographic image |
618 |
615 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
72 |
52 |
$6K |
| D1999 |
|
119 |
119 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
204 |
197 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
714 |
670 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
132 |
132 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
25 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
72 |
72 |
$1K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
17 |
17 |
$834.75 |
| D1510 |
|
16 |
15 |
$520.80 |
| D9986 |
|
551 |
542 |
$88.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
17 |
17 |
$0.00 |