| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
34,226 |
33,536 |
$1.24M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,840 |
7,697 |
$1.10M |
| D0120 |
Periodic oral evaluation - established patient |
38,281 |
37,519 |
$1.08M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,892 |
6,758 |
$750K |
| D1110 |
Prophylaxis - adult |
13,926 |
13,644 |
$702K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15,760 |
14,736 |
$606K |
| D0330 |
Panoramic radiographic image |
9,333 |
9,153 |
$570K |
| D1208 |
Topical application of fluoride, excluding varnish |
26,607 |
26,093 |
$538K |
| D7240 |
Removal of impacted tooth - completely bony |
2,100 |
662 |
$500K |
| D1206 |
Topical application of fluoride varnish |
16,873 |
16,520 |
$439K |
| D0272 |
Bitewings - two radiographic images |
15,316 |
14,971 |
$325K |
| D0210 |
Intraoral - complete series of radiographic images |
6,573 |
6,559 |
$322K |
| D1351 |
Sealant - per tooth |
8,487 |
2,839 |
$250K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,677 |
4,567 |
$224K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,716 |
831 |
$221K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,200 |
4,058 |
$204K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33,714 |
11,388 |
$181K |
| D0220 |
Intraoral - periapical first radiographic image |
16,856 |
16,221 |
$137K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,053 |
674 |
$81K |
| D0140 |
Limited oral evaluation - problem focused |
3,539 |
3,441 |
$52K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
263 |
213 |
$41K |
| D9243 |
|
624 |
282 |
$30K |
| D9239 |
|
402 |
306 |
$23K |
| D9222 |
|
111 |
95 |
$14K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
107 |
85 |
$8K |
| D9920 |
|
122 |
102 |
$7K |
| D9420 |
|
66 |
64 |
$7K |
| D7111 |
|
103 |
72 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
25 |
12 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
30 |
15 |
$2K |
| D9986 |
|
1,063 |
1,036 |
$0.00 |