| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,387 |
14,176 |
$399K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,436 |
1,110 |
$233K |
| D0120 |
Periodic oral evaluation - established patient |
15,031 |
12,890 |
$210K |
| D1206 |
Topical application of fluoride varnish |
16,891 |
14,528 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,589 |
2,261 |
$96K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,949 |
940 |
$78K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,975 |
1,320 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,676 |
913 |
$50K |
| D1354 |
|
5,838 |
1,136 |
$46K |
| D1351 |
Sealant - per tooth |
9,273 |
2,159 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,852 |
3,239 |
$32K |
| D1110 |
Prophylaxis - adult |
860 |
673 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,834 |
3,483 |
$23K |
| D0272 |
Bitewings - two radiographic images |
12,980 |
11,117 |
$21K |
| D0330 |
Panoramic radiographic image |
574 |
459 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
5,565 |
4,766 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
1,261 |
999 |
$14K |
| D1330 |
|
17,413 |
14,996 |
$11K |
| D9999 |
Unspecified adjunctive procedure, by report |
75 |
75 |
$2K |
| D1510 |
|
26 |
13 |
$2K |
| D1999 |
|
902 |
849 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$1K |
| D0274 |
Bitewings - four radiographic images |
760 |
598 |
$259.58 |
| D9420 |
|
98 |
80 |
$250.20 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
385 |
136 |
$0.00 |
| D0601 |
|
20 |
20 |
$0.00 |