| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
1,308 |
1,297 |
$316K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
302 |
75 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
99 |
42 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
89 |
30 |
$3K |
| D1351 |
Sealant - per tooth |
188 |
56 |
$1K |
| D9420 |
|
28 |
24 |
$871.44 |
| D0230 |
Intraoral - periapical each additional radiographic image |
131 |
57 |
$628.72 |
| D0220 |
Intraoral - periapical first radiographic image |
143 |
110 |
$602.88 |
| D0272 |
Bitewings - two radiographic images |
483 |
422 |
$315.43 |
| D0240 |
|
1,104 |
479 |
$249.48 |
| D1120 |
Prophylaxis - child |
912 |
815 |
$110.25 |
| D0120 |
Periodic oral evaluation - established patient |
773 |
678 |
$57.70 |
| D1206 |
Topical application of fluoride varnish |
600 |
525 |
$29.40 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
29 |
28 |
$27.11 |
| D0601 |
|
573 |
499 |
$0.00 |
| D0603 |
|
479 |
418 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
199 |
155 |
$0.00 |
| D0602 |
|
87 |
77 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
42 |
33 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
278 |
244 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
90 |
62 |
$0.00 |
| D1110 |
Prophylaxis - adult |
244 |
203 |
$0.00 |