| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
33,957 |
33,694 |
$953K |
| D1351 |
Sealant - per tooth |
49,528 |
11,841 |
$944K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,571 |
7,909 |
$621K |
| D0120 |
Periodic oral evaluation - established patient |
22,617 |
22,471 |
$544K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,696 |
2,806 |
$488K |
| D1206 |
Topical application of fluoride varnish |
19,322 |
19,181 |
$381K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,152 |
2,706 |
$329K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,986 |
9,909 |
$244K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,944 |
3,371 |
$230K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,124 |
3,612 |
$199K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,967 |
13,841 |
$194K |
| D9420 |
|
916 |
833 |
$169K |
| D9920 |
|
7,978 |
6,514 |
$124K |
| D0140 |
Limited oral evaluation - problem focused |
3,901 |
3,845 |
$103K |
| D0272 |
Bitewings - two radiographic images |
12,178 |
12,087 |
$92K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,348 |
7,215 |
$84K |
| D0330 |
Panoramic radiographic image |
3,635 |
3,600 |
$82K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,635 |
1,345 |
$81K |
| D0602 |
|
10,538 |
10,445 |
$72K |
| D0601 |
|
10,286 |
10,181 |
$68K |
| D0603 |
|
9,340 |
9,272 |
$57K |
| D0274 |
Bitewings - four radiographic images |
4,296 |
4,282 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
1,267 |
1,267 |
$50K |
| D2331 |
|
872 |
584 |
$38K |
| D1110 |
Prophylaxis - adult |
1,274 |
1,265 |
$36K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,703 |
1,692 |
$28K |
| D1510 |
|
293 |
229 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,477 |
1,760 |
$20K |
| D2332 |
|
380 |
221 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
3,401 |
3,205 |
$16K |
| D9999 |
Unspecified adjunctive procedure, by report |
349 |
301 |
$13K |
| D0270 |
|
1,652 |
1,645 |
$11K |
| D2933 |
|
69 |
25 |
$11K |
| D0273 |
|
496 |
492 |
$6K |
| D2335 |
|
93 |
64 |
$5K |
| D2330 |
|
82 |
67 |
$3K |
| D0170 |
|
172 |
169 |
$2K |
| D7111 |
|
15 |
15 |
$625.00 |
| D1354 |
|
41 |
13 |
$145.00 |
| D9910 |
|
124 |
91 |
$20.00 |
| D1999 |
|
1,781 |
1,628 |
$0.00 |