| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,803 |
9,751 |
$528K |
| D1110 |
Prophylaxis - adult |
3,519 |
3,496 |
$232K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,811 |
1,269 |
$157K |
| D0330 |
Panoramic radiographic image |
1,917 |
1,907 |
$151K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
974 |
723 |
$120K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,481 |
1,114 |
$79K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,557 |
11,761 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,455 |
1,449 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
414 |
413 |
$52K |
| D1351 |
Sealant - per tooth |
5,397 |
1,593 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,161 |
13,093 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
11,344 |
11,285 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,521 |
2,408 |
$22K |
| D9920 |
|
1,771 |
1,765 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
385 |
290 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
734 |
723 |
$11K |
| D1330 |
|
13,155 |
13,086 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
12,321 |
12,054 |
$8K |
| D0272 |
Bitewings - two radiographic images |
6,579 |
6,539 |
$7K |
| D0274 |
Bitewings - four radiographic images |
2,408 |
2,391 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
367 |
366 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
39 |
39 |
$975.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
29 |
29 |
$580.00 |