| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,100 |
8,950 |
$391K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,263 |
2,222 |
$128K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
785 |
474 |
$123K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,328 |
1,125 |
$116K |
| D1110 |
Prophylaxis - adult |
1,750 |
1,730 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
8,639 |
8,491 |
$89K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,128 |
4,537 |
$57K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,065 |
715 |
$46K |
| D1351 |
Sealant - per tooth |
5,872 |
1,656 |
$45K |
| D1206 |
Topical application of fluoride varnish |
9,183 |
9,033 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
697 |
422 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,848 |
1,678 |
$21K |
| D0330 |
Panoramic radiographic image |
343 |
337 |
$18K |
| D9999 |
Unspecified adjunctive procedure, by report |
322 |
317 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
730 |
443 |
$10K |
| D0272 |
Bitewings - two radiographic images |
5,070 |
4,974 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
713 |
685 |
$9K |
| D1330 |
|
10,888 |
10,697 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
5,451 |
5,328 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,617 |
1,601 |
$5K |
| D0274 |
Bitewings - four radiographic images |
1,666 |
1,644 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
13 |
$3K |
| D3120 |
|
285 |
169 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
26 |
26 |
$520.00 |
| D0602 |
|
327 |
326 |
$325.00 |
| D0603 |
|
265 |
265 |
$265.00 |
| D1354 |
|
31 |
12 |
$123.00 |
| D0601 |
|
113 |
113 |
$113.00 |
| D9986 |
|
81 |
79 |
$0.00 |