| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,315 |
11,345 |
$486K |
| D1206 |
Topical application of fluoride varnish |
12,408 |
11,492 |
$401K |
| D1351 |
Sealant - per tooth |
11,932 |
3,097 |
$235K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,371 |
2,067 |
$202K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,299 |
1,067 |
$194K |
| D0120 |
Periodic oral evaluation - established patient |
6,989 |
6,555 |
$159K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,468 |
5,079 |
$158K |
| D0272 |
Bitewings - two radiographic images |
7,895 |
7,338 |
$125K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,588 |
7,794 |
$112K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,404 |
1,222 |
$83K |
| D0330 |
Panoramic radiographic image |
1,892 |
1,793 |
$66K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,689 |
3,996 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
6,593 |
5,976 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,505 |
785 |
$54K |
| D9248 |
|
477 |
403 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
927 |
834 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,128 |
1,049 |
$23K |
| D0240 |
|
1,672 |
1,381 |
$21K |
| D0999 |
Unspecified diagnostic procedure, by report |
355 |
355 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
256 |
113 |
$10K |
| D1354 |
|
791 |
153 |
$9K |
| D9999 |
Unspecified adjunctive procedure, by report |
438 |
438 |
$9K |
| D0603 |
|
3,029 |
2,697 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
149 |
90 |
$7K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
69 |
12 |
$5K |
| D9310 |
|
152 |
109 |
$4K |
| D1110 |
Prophylaxis - adult |
105 |
96 |
$4K |
| D0601 |
|
943 |
833 |
$2K |
| D9993 |
|
515 |
486 |
$2K |
| D9994 |
|
497 |
476 |
$2K |
| D1510 |
|
17 |
14 |
$2K |
| D2330 |
|
32 |
12 |
$1K |
| D9222 |
|
14 |
12 |
$1K |
| D1999 |
|
298 |
283 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
17 |
$943.04 |
| D0602 |
|
805 |
681 |
$631.00 |
| D3120 |
|
40 |
24 |
$488.50 |
| D9215 |
|
386 |
363 |
$158.55 |
| D1310 |
|
564 |
531 |
$0.00 |
| D1330 |
|
568 |
534 |
$0.00 |
| D9986 |
|
37 |
36 |
$0.00 |
| D9987 |
|
12 |
12 |
$0.00 |