| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,865 |
7,699 |
$299K |
| D1206 |
Topical application of fluoride varnish |
7,996 |
7,838 |
$233K |
| D0120 |
Periodic oral evaluation - established patient |
5,147 |
5,073 |
$207K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,729 |
1,236 |
$96K |
| D1310 |
|
4,685 |
4,537 |
$91K |
| D0220 |
Intraoral - periapical first radiographic image |
6,877 |
6,730 |
$78K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,158 |
1,960 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,689 |
1,654 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,639 |
6,066 |
$59K |
| D0274 |
Bitewings - four radiographic images |
2,354 |
2,342 |
$48K |
| D1351 |
Sealant - per tooth |
1,028 |
469 |
$36K |
| D0145 |
Oral evaluation for a patient under three years of age |
680 |
646 |
$36K |
| D9999 |
Unspecified adjunctive procedure, by report |
382 |
350 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
444 |
348 |
$22K |
| D0603 |
|
3,339 |
3,255 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,505 |
1,484 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
216 |
164 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
77 |
54 |
$9K |
| D0999 |
Unspecified diagnostic procedure, by report |
130 |
130 |
$8K |
| D0350 |
|
1,081 |
615 |
$6K |
| D1354 |
|
826 |
226 |
$5K |
| D0601 |
|
350 |
346 |
$4K |
| D9430 |
|
107 |
107 |
$3K |
| D0602 |
|
545 |
518 |
$3K |
| D1110 |
Prophylaxis - adult |
62 |
61 |
$2K |
| D0330 |
Panoramic radiographic image |
88 |
86 |
$2K |
| D1999 |
|
45 |
45 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
16 |
$1K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
14 |
12 |
$994.00 |
| D9993 |
|
2,425 |
2,327 |
$0.00 |