| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
35,098 |
33,890 |
$928K |
| D1120 |
Prophylaxis - child |
36,163 |
34,642 |
$829K |
| D1208 |
Topical application of fluoride, excluding varnish |
37,255 |
35,705 |
$705K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,918 |
1,114 |
$587K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,738 |
3,784 |
$453K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,118 |
3,264 |
$339K |
| D9999 |
Unspecified adjunctive procedure, by report |
9,948 |
9,498 |
$281K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,663 |
7,128 |
$262K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,343 |
9,178 |
$226K |
| D1110 |
Prophylaxis - adult |
5,990 |
5,752 |
$224K |
| D1351 |
Sealant - per tooth |
8,895 |
2,574 |
$210K |
| D0272 |
Bitewings - two radiographic images |
15,678 |
14,995 |
$152K |
| D0330 |
Panoramic radiographic image |
3,550 |
3,421 |
$135K |
| D0140 |
Limited oral evaluation - problem focused |
5,011 |
4,755 |
$102K |
| D1999 |
|
7,454 |
6,787 |
$63K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
834 |
312 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
6,072 |
5,755 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
851 |
480 |
$45K |
| D0274 |
Bitewings - four radiographic images |
3,073 |
2,967 |
$43K |
| D0240 |
|
5,054 |
2,595 |
$41K |
| D1206 |
Topical application of fluoride varnish |
573 |
567 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,619 |
1,790 |
$6K |
| D1354 |
|
1,414 |
498 |
$4K |
| D9920 |
|
145 |
135 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
53 |
36 |
$3K |
| D2332 |
|
20 |
14 |
$3K |
| D2330 |
|
28 |
17 |
$2K |
| D9630 |
|
21 |
21 |
$945.00 |
| D9995 |
|
14 |
14 |
$140.00 |
| D0171 |
|
81 |
80 |
$0.00 |
| D0602 |
|
1,219 |
1,179 |
$0.00 |
| D0601 |
|
909 |
881 |
$0.00 |
| D3120 |
|
715 |
426 |
$0.00 |
| D0170 |
|
110 |
96 |
$0.00 |
| D0603 |
|
2,698 |
2,600 |
$0.00 |