| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
23,576 |
23,229 |
$618K |
| D0120 |
Periodic oral evaluation - established patient |
26,584 |
26,281 |
$571K |
| D1206 |
Topical application of fluoride varnish |
23,372 |
23,057 |
$385K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,055 |
2,687 |
$328K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,131 |
563 |
$287K |
| D1110 |
Prophylaxis - adult |
5,729 |
5,664 |
$261K |
| D1351 |
Sealant - per tooth |
12,652 |
3,122 |
$237K |
| D9999 |
Unspecified adjunctive procedure, by report |
5,964 |
5,838 |
$180K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,656 |
1,966 |
$179K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,718 |
1,281 |
$133K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,731 |
5,395 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,750 |
2,657 |
$99K |
| D0272 |
Bitewings - two radiographic images |
10,423 |
10,276 |
$83K |
| D0330 |
Panoramic radiographic image |
1,990 |
1,964 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
7,530 |
7,297 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
2,242 |
2,155 |
$43K |
| D0274 |
Bitewings - four radiographic images |
3,117 |
3,083 |
$35K |
| D9248 |
|
531 |
500 |
$34K |
| D1999 |
|
3,229 |
3,041 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,773 |
1,760 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
159 |
108 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
175 |
82 |
$12K |
| D9920 |
|
251 |
245 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,215 |
1,967 |
$6K |
| D7111 |
|
38 |
24 |
$861.00 |
| D1354 |
|
25 |
12 |
$105.00 |