| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
15,518 |
15,104 |
$429K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,701 |
553 |
$398K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,950 |
2,846 |
$345K |
| D1206 |
Topical application of fluoride varnish |
16,095 |
15,573 |
$329K |
| D1120 |
Prophylaxis - child |
13,452 |
13,020 |
$320K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,216 |
1,495 |
$176K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,002 |
1,269 |
$162K |
| D1351 |
Sealant - per tooth |
6,619 |
1,615 |
$159K |
| D1110 |
Prophylaxis - adult |
3,758 |
3,650 |
$149K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,033 |
4,413 |
$110K |
| D9999 |
Unspecified adjunctive procedure, by report |
3,066 |
2,910 |
$89K |
| D0272 |
Bitewings - two radiographic images |
8,855 |
8,562 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,503 |
1,011 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,759 |
1,637 |
$70K |
| D9248 |
|
1,207 |
1,085 |
$69K |
| D0330 |
Panoramic radiographic image |
1,117 |
1,078 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
4,003 |
3,732 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,874 |
1,829 |
$25K |
| D0240 |
|
3,460 |
1,892 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
1,016 |
972 |
$22K |
| D2929 |
|
52 |
12 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,548 |
2,102 |
$10K |
| D9630 |
|
26 |
21 |
$760.98 |
| D7111 |
|
18 |
12 |
$516.60 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$355.81 |
| D1999 |
|
641 |
594 |
$0.00 |
| D1330 |
|
141 |
141 |
$0.00 |