| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,198 |
6,913 |
$241K |
| D0120 |
Periodic oral evaluation - established patient |
7,869 |
7,524 |
$177K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,509 |
8,037 |
$173K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,378 |
1,249 |
$169K |
| D0220 |
Intraoral - periapical first radiographic image |
9,099 |
8,682 |
$107K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
923 |
319 |
$102K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
452 |
215 |
$96K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,821 |
4,637 |
$76K |
| D0272 |
Bitewings - two radiographic images |
3,692 |
3,530 |
$68K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
906 |
241 |
$66K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,410 |
2,182 |
$58K |
| D0274 |
Bitewings - four radiographic images |
1,999 |
1,903 |
$53K |
| D1110 |
Prophylaxis - adult |
1,204 |
1,143 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
270 |
181 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
203 |
107 |
$14K |
| D2390 |
|
83 |
24 |
$14K |
| D1351 |
Sealant - per tooth |
493 |
144 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
201 |
197 |
$7K |
| D9612 |
|
165 |
156 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
94 |
92 |
$3K |
| D9410 |
|
41 |
41 |
$2K |
| D1206 |
Topical application of fluoride varnish |
109 |
102 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
33 |
33 |
$2K |
| D9310 |
|
40 |
40 |
$2K |
| D1999 |
|
434 |
431 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
70 |
68 |
$971.54 |
| D9222 |
|
13 |
13 |
$930.02 |
| D9110 |
|
14 |
13 |
$452.37 |