| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,742 |
14,481 |
$590K |
| D1206 |
Topical application of fluoride varnish |
16,198 |
15,935 |
$501K |
| D0120 |
Periodic oral evaluation - established patient |
11,345 |
11,190 |
$496K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,633 |
2,121 |
$406K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,150 |
1,893 |
$290K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,845 |
12,378 |
$280K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,256 |
3,025 |
$269K |
| D1310 |
|
9,269 |
9,041 |
$262K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,775 |
5,324 |
$217K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,807 |
3,728 |
$206K |
| D1351 |
Sealant - per tooth |
6,066 |
2,485 |
$193K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,887 |
1,942 |
$158K |
| D0220 |
Intraoral - periapical first radiographic image |
12,764 |
12,532 |
$149K |
| D1110 |
Prophylaxis - adult |
1,554 |
1,554 |
$138K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,291 |
1,584 |
$115K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,827 |
1,792 |
$104K |
| D0272 |
Bitewings - two radiographic images |
7,080 |
7,000 |
$81K |
| D0603 |
|
8,444 |
8,250 |
$80K |
| D9430 |
|
2,294 |
2,158 |
$71K |
| D9999 |
Unspecified adjunctive procedure, by report |
827 |
784 |
$67K |
| D0350 |
|
3,991 |
3,371 |
$66K |
| D0274 |
Bitewings - four radiographic images |
3,078 |
3,073 |
$65K |
| D1999 |
|
3,518 |
3,165 |
$26K |
| D1510 |
|
113 |
107 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
263 |
237 |
$21K |
| D9993 |
|
3,738 |
3,535 |
$12K |
| D0999 |
Unspecified diagnostic procedure, by report |
174 |
174 |
$10K |
| D2332 |
|
80 |
56 |
$7K |
| D2330 |
|
36 |
26 |
$3K |
| D2335 |
|
20 |
13 |
$2K |
| D0602 |
|
421 |
406 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
20 |
$768.00 |
| D1354 |
|
132 |
24 |
$530.00 |
| D1330 |
|
1,711 |
1,710 |
$0.00 |
| D9986 |
|
100 |
88 |
$0.00 |
| D9987 |
|
24 |
23 |
$0.00 |