| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,013 |
11,766 |
$410K |
| D0120 |
Periodic oral evaluation - established patient |
11,117 |
10,905 |
$237K |
| D1351 |
Sealant - per tooth |
9,249 |
1,997 |
$195K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,581 |
8,373 |
$188K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,431 |
1,999 |
$186K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,185 |
1,393 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,748 |
1,716 |
$66K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,063 |
3,741 |
$53K |
| D7140 |
Extraction, erupted tooth or exposed root |
798 |
502 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,470 |
1,411 |
$43K |
| D0272 |
Bitewings - two radiographic images |
3,842 |
3,779 |
$32K |
| D0603 |
|
5,050 |
4,941 |
$29K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
220 |
136 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
407 |
399 |
$19K |
| D0330 |
Panoramic radiographic image |
758 |
745 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
3,826 |
3,709 |
$17K |
| D0240 |
|
1,053 |
1,033 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,134 |
3,021 |
$14K |
| D0274 |
Bitewings - four radiographic images |
1,512 |
1,476 |
$14K |
| D9248 |
|
74 |
69 |
$14K |
| D0602 |
|
2,351 |
2,314 |
$14K |
| D1206 |
Topical application of fluoride varnish |
3,785 |
3,755 |
$14K |
| D0601 |
|
1,580 |
1,544 |
$9K |
| D1110 |
Prophylaxis - adult |
300 |
296 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
42 |
27 |
$3K |
| D9920 |
|
270 |
250 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$420.00 |
| D1310 |
|
259 |
252 |
$0.00 |
| D1330 |
|
1,035 |
1,019 |
$0.00 |
| D1999 |
|
1,859 |
1,808 |
$0.00 |