| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2394 |
|
3,144 |
1,326 |
$328K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,650 |
852 |
$140K |
| D1999 |
|
5,105 |
4,066 |
$87K |
| D1120 |
Prophylaxis - child |
3,098 |
2,889 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,001 |
4,598 |
$65K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,097 |
2,278 |
$65K |
| D0330 |
Panoramic radiographic image |
1,542 |
1,354 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
3,363 |
3,192 |
$59K |
| D1110 |
Prophylaxis - adult |
1,834 |
1,640 |
$59K |
| D1354 |
|
2,576 |
516 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,783 |
1,537 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,907 |
1,740 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,015 |
888 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,062 |
975 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,107 |
962 |
$22K |
| D3120 |
|
835 |
411 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,507 |
1,311 |
$14K |
| D2335 |
|
147 |
42 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,064 |
392 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
194 |
50 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
124 |
37 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
45 |
25 |
$5K |
| D1351 |
Sealant - per tooth |
188 |
39 |
$4K |
| D9110 |
|
28 |
25 |
$983.40 |
| D9999 |
Unspecified adjunctive procedure, by report |
388 |
183 |
$0.00 |