| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
17,769 |
17,168 |
$405K |
| D1120 |
Prophylaxis - child |
16,534 |
15,907 |
$359K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,466 |
675 |
$332K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,128 |
2,147 |
$272K |
| D1351 |
Sealant - per tooth |
12,901 |
3,249 |
$253K |
| D1206 |
Topical application of fluoride varnish |
11,764 |
11,515 |
$186K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,517 |
1,350 |
$150K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,445 |
5,856 |
$120K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,753 |
7,253 |
$115K |
| D9999 |
Unspecified adjunctive procedure, by report |
4,356 |
4,173 |
$108K |
| D1110 |
Prophylaxis - adult |
3,189 |
3,080 |
$105K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,274 |
720 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,096 |
1,962 |
$73K |
| D0140 |
Limited oral evaluation - problem focused |
3,733 |
3,358 |
$68K |
| D0330 |
Panoramic radiographic image |
1,425 |
1,386 |
$55K |
| D0272 |
Bitewings - two radiographic images |
5,076 |
4,877 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
6,316 |
5,938 |
$47K |
| D2140 |
|
913 |
599 |
$45K |
| D1999 |
|
3,594 |
3,318 |
$43K |
| D0274 |
Bitewings - four radiographic images |
2,384 |
2,302 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,940 |
4,124 |
$31K |
| D9248 |
|
629 |
558 |
$28K |
| D0240 |
|
3,857 |
2,009 |
$24K |
| D7962 |
|
265 |
247 |
$22K |
| D7960 |
|
270 |
128 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
197 |
145 |
$10K |
| D7961 |
|
95 |
87 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
87 |
46 |
$7K |
| D9610 |
|
143 |
141 |
$5K |
| D9992 |
|
15 |
13 |
$120.00 |
| D0171 |
|
89 |
89 |
$0.00 |
| D9934 |
|
17 |
13 |
$0.00 |
| D0350 |
|
600 |
467 |
$0.00 |