| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
26,622 |
25,521 |
$694K |
| D1120 |
Prophylaxis - child |
26,434 |
25,061 |
$596K |
| D1206 |
Topical application of fluoride varnish |
30,782 |
28,268 |
$562K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,816 |
3,537 |
$422K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,925 |
1,207 |
$340K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,808 |
2,748 |
$246K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,443 |
5,748 |
$211K |
| D9999 |
Unspecified adjunctive procedure, by report |
8,108 |
7,501 |
$196K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,399 |
2,130 |
$178K |
| D1110 |
Prophylaxis - adult |
4,092 |
3,895 |
$147K |
| D1351 |
Sealant - per tooth |
4,833 |
1,640 |
$101K |
| D0272 |
Bitewings - two radiographic images |
9,496 |
8,963 |
$91K |
| D0140 |
Limited oral evaluation - problem focused |
3,965 |
3,694 |
$79K |
| D9630 |
|
1,844 |
1,757 |
$77K |
| D0330 |
Panoramic radiographic image |
1,879 |
1,800 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
8,533 |
7,747 |
$65K |
| D1999 |
|
12,813 |
10,831 |
$51K |
| D0274 |
Bitewings - four radiographic images |
3,464 |
3,328 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,286 |
4,336 |
$27K |
| D9248 |
|
456 |
377 |
$21K |
| D1354 |
|
2,995 |
929 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
225 |
210 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
254 |
254 |
$4K |
| D2332 |
|
45 |
24 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
54 |
37 |
$3K |
| D2330 |
|
53 |
39 |
$3K |
| D0240 |
|
405 |
213 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
14 |
$1K |
| D9992 |
|
19 |
17 |
$285.00 |
| D0350 |
|
3,387 |
3,044 |
$0.00 |
| D0603 |
|
8,100 |
7,727 |
$0.00 |
| D0602 |
|
4,108 |
3,900 |
$0.00 |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
453 |
406 |
$0.00 |
| D0601 |
|
13,967 |
13,321 |
$0.00 |