| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
24,004 |
23,841 |
$1.21M |
| D1110 |
Prophylaxis - adult |
18,300 |
18,146 |
$1.18M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,118 |
7,453 |
$744K |
| D0120 |
Periodic oral evaluation - established patient |
36,937 |
36,661 |
$543K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,583 |
973 |
$266K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,326 |
3,564 |
$192K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,646 |
1,201 |
$190K |
| D0330 |
Panoramic radiographic image |
4,174 |
4,134 |
$173K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,963 |
4,915 |
$167K |
| D0240 |
|
1,954 |
1,657 |
$136K |
| D1206 |
Topical application of fluoride varnish |
39,800 |
39,514 |
$130K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,002 |
9,387 |
$101K |
| D0274 |
Bitewings - four radiographic images |
16,714 |
16,585 |
$93K |
| D1330 |
|
42,851 |
42,529 |
$82K |
| D1351 |
Sealant - per tooth |
14,014 |
4,078 |
$81K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,757 |
1,187 |
$73K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,887 |
1,872 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
33,189 |
32,434 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
38,372 |
28,522 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
3,657 |
3,587 |
$50K |
| D0272 |
Bitewings - two radiographic images |
17,967 |
17,859 |
$45K |
| D1999 |
|
6,352 |
6,181 |
$20K |
| D0601 |
|
5,897 |
5,835 |
$18K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,052 |
649 |
$15K |
| D7111 |
|
268 |
200 |
$13K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
36 |
27 |
$9K |
| D2332 |
|
109 |
77 |
$6K |
| D0999 |
Unspecified diagnostic procedure, by report |
255 |
255 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
122 |
120 |
$3K |
| D2335 |
|
18 |
12 |
$2K |
| D0602 |
|
1,716 |
1,703 |
$2K |
| D1510 |
|
13 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,026 |
1,001 |
$2K |
| D2331 |
|
61 |
40 |
$1K |
| D0603 |
|
2,008 |
1,981 |
$1K |
| D4346 |
|
47 |
44 |
$851.82 |
| D9310 |
|
69 |
69 |
$847.00 |
| D3120 |
|
667 |
490 |
$752.00 |
| D1354 |
|
71 |
28 |
$528.90 |
| D0350 |
|
1,285 |
1,285 |
$300.00 |
| D0270 |
|
64 |
61 |
$8.00 |
| D1310 |
|
47 |
47 |
$0.00 |