| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9420 |
|
544 |
451 |
$171K |
| D0120 |
Periodic oral evaluation - established patient |
3,130 |
3,032 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,092 |
2,036 |
$64K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
843 |
797 |
$48K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,042 |
521 |
$46K |
| D0272 |
Bitewings - two radiographic images |
2,665 |
2,595 |
$28K |
| D1330 |
|
4,799 |
4,557 |
$27K |
| D9248 |
|
109 |
109 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,930 |
785 |
$17K |
| D1351 |
Sealant - per tooth |
1,758 |
470 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
614 |
354 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
2,110 |
2,018 |
$14K |
| D1120 |
Prophylaxis - child |
3,762 |
3,588 |
$12K |
| D7960 |
|
62 |
51 |
$9K |
| D0240 |
|
546 |
417 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
595 |
567 |
$8K |
| D1206 |
Topical application of fluoride varnish |
2,266 |
2,171 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,311 |
2,166 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
558 |
299 |
$6K |
| D1110 |
Prophylaxis - adult |
743 |
721 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
519 |
200 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,327 |
1,027 |
$3K |
| D0274 |
Bitewings - four radiographic images |
113 |
113 |
$2K |
| D2330 |
|
85 |
34 |
$2K |
| D1999 |
|
35 |
35 |
$2K |
| D0330 |
Panoramic radiographic image |
113 |
113 |
$1K |
| D0350 |
|
292 |
276 |
$638.32 |
| D2335 |
|
212 |
75 |
$335.90 |
| D9999 |
Unspecified adjunctive procedure, by report |
234 |
224 |
$0.00 |
| D3120 |
|
71 |
40 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
202 |
191 |
$0.00 |
| D7962 |
|
12 |
12 |
$0.00 |