| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,672 |
10,541 |
$427K |
| D1110 |
Prophylaxis - adult |
4,959 |
4,891 |
$266K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,134 |
2,661 |
$217K |
| D0120 |
Periodic oral evaluation - established patient |
14,378 |
14,203 |
$124K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,729 |
1,810 |
$99K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,194 |
518 |
$77K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
870 |
643 |
$72K |
| D1351 |
Sealant - per tooth |
7,052 |
1,775 |
$61K |
| D9420 |
|
121 |
106 |
$51K |
| D1330 |
|
15,605 |
15,411 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,920 |
13,755 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
960 |
952 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
9,378 |
9,068 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,806 |
1,086 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,122 |
1,944 |
$30K |
| D9248 |
|
117 |
113 |
$30K |
| D0330 |
Panoramic radiographic image |
750 |
743 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
2,087 |
2,005 |
$24K |
| D0274 |
Bitewings - four radiographic images |
3,378 |
3,331 |
$18K |
| D0272 |
Bitewings - two radiographic images |
4,281 |
4,232 |
$16K |
| D2390 |
|
104 |
42 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
575 |
320 |
$7K |
| D1510 |
|
61 |
48 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,552 |
8,177 |
$4K |
| D3120 |
|
678 |
409 |
$4K |
| D2330 |
|
100 |
55 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
117 |
114 |
$2K |
| D2332 |
|
17 |
12 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$240.00 |
| D1999 |
|
263 |
258 |
$7.50 |
| D0350 |
|
28 |
25 |
$0.00 |