| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
39,561 |
38,463 |
$2.19M |
| D1206 |
Topical application of fluoride varnish |
39,293 |
38,191 |
$2.03M |
| D0120 |
Periodic oral evaluation - established patient |
28,850 |
28,212 |
$927K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,681 |
2,631 |
$755K |
| D0272 |
Bitewings - two radiographic images |
30,188 |
29,235 |
$611K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,239 |
3,330 |
$412K |
| D0230 |
Intraoral - periapical each additional radiographic image |
68,172 |
40,565 |
$395K |
| D1351 |
Sealant - per tooth |
16,837 |
3,411 |
$370K |
| D0220 |
Intraoral - periapical first radiographic image |
21,122 |
20,399 |
$361K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,644 |
10,274 |
$332K |
| D9248 |
|
3,466 |
3,209 |
$291K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,084 |
2,555 |
$203K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,280 |
890 |
$120K |
| D0330 |
Panoramic radiographic image |
2,958 |
2,847 |
$116K |
| D0140 |
Limited oral evaluation - problem focused |
3,341 |
3,233 |
$106K |
| D2933 |
|
718 |
215 |
$79K |
| D0603 |
|
15,077 |
14,883 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,786 |
950 |
$66K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,545 |
7,099 |
$65K |
| D0274 |
Bitewings - four radiographic images |
2,724 |
2,643 |
$62K |
| D1510 |
|
314 |
230 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
614 |
335 |
$32K |
| D0999 |
Unspecified diagnostic procedure, by report |
996 |
996 |
$30K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,205 |
1,205 |
$23K |
| D2330 |
|
292 |
184 |
$16K |
| D0601 |
|
2,798 |
2,765 |
$13K |
| D9310 |
|
266 |
224 |
$12K |
| D2332 |
|
149 |
87 |
$11K |
| D2335 |
|
159 |
43 |
$9K |
| D1999 |
|
380 |
375 |
$3K |
| D0190 |
|
108 |
106 |
$2K |
| D1110 |
Prophylaxis - adult |
27 |
26 |
$1K |
| D1354 |
|
27 |
12 |
$332.10 |
| D9420 |
|
89 |
58 |
$0.00 |
| D9986 |
|
647 |
621 |
$0.00 |
| D0350 |
|
12 |
12 |
$0.00 |