| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
38,942 |
38,548 |
$1.43M |
| D0120 |
Periodic oral evaluation - established patient |
42,822 |
42,375 |
$1.23M |
| D1110 |
Prophylaxis - adult |
17,151 |
16,952 |
$876K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,648 |
1,205 |
$860K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,415 |
6,425 |
$841K |
| D7240 |
Removal of impacted tooth - completely bony |
2,728 |
912 |
$682K |
| D1208 |
Topical application of fluoride, excluding varnish |
32,253 |
31,886 |
$670K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,822 |
6,986 |
$664K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16,998 |
15,548 |
$648K |
| D0272 |
Bitewings - two radiographic images |
24,081 |
23,824 |
$533K |
| D1206 |
Topical application of fluoride varnish |
18,605 |
18,414 |
$487K |
| D0330 |
Panoramic radiographic image |
7,761 |
7,628 |
$478K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,478 |
7,373 |
$378K |
| D0210 |
Intraoral - complete series of radiographic images |
5,907 |
5,895 |
$325K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,537 |
5,478 |
$275K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,754 |
1,608 |
$211K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,109 |
564 |
$191K |
| D1351 |
Sealant - per tooth |
5,872 |
1,876 |
$178K |
| D0220 |
Intraoral - periapical first radiographic image |
16,698 |
16,269 |
$150K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,715 |
10,045 |
$115K |
| D0140 |
Limited oral evaluation - problem focused |
5,493 |
5,373 |
$81K |
| D9420 |
|
748 |
693 |
$72K |
| D9248 |
|
282 |
262 |
$44K |
| D9239 |
|
561 |
445 |
$38K |
| D9243 |
|
711 |
329 |
$37K |
| D2390 |
|
95 |
39 |
$28K |
| D9222 |
|
172 |
156 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
180 |
144 |
$20K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
114 |
102 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
80 |
71 |
$10K |
| D2330 |
|
100 |
64 |
$8K |
| D7111 |
|
43 |
36 |
$3K |
| D9920 |
|
14 |
12 |
$841.20 |
| D9987 |
|
238 |
234 |
$0.00 |
| D9986 |
|
1,016 |
997 |
$0.00 |
| D0170 |
|
28 |
25 |
$0.00 |
| D9310 |
|
60 |
60 |
$0.00 |