| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
24,908 |
23,937 |
$665K |
| D1120 |
Prophylaxis - child |
27,694 |
26,541 |
$637K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,155 |
3,341 |
$491K |
| D1206 |
Topical application of fluoride varnish |
19,853 |
19,153 |
$422K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,998 |
858 |
$278K |
| D9999 |
Unspecified adjunctive procedure, by report |
7,767 |
7,400 |
$232K |
| D0220 |
Intraoral - periapical first radiographic image |
26,429 |
25,149 |
$208K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,901 |
8,953 |
$207K |
| D0272 |
Bitewings - two radiographic images |
20,026 |
19,178 |
$194K |
| D1351 |
Sealant - per tooth |
7,088 |
2,053 |
$148K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,760 |
7,298 |
$128K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,162 |
1,258 |
$118K |
| D0230 |
Intraoral - periapical each additional radiographic image |
47,006 |
23,824 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,407 |
2,246 |
$98K |
| D0140 |
Limited oral evaluation - problem focused |
2,496 |
2,360 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
906 |
498 |
$49K |
| D0330 |
Panoramic radiographic image |
1,140 |
1,087 |
$43K |
| D1999 |
|
2,905 |
2,708 |
$36K |
| D9630 |
|
203 |
200 |
$9K |
| D9248 |
|
110 |
105 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
35 |
24 |
$3K |
| D1110 |
Prophylaxis - adult |
55 |
55 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
113 |
108 |
$1K |
| D1354 |
|
187 |
39 |
$546.60 |
| D1330 |
|
14 |
14 |
$0.00 |