| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
23,334 |
22,823 |
$1.04M |
| D1110 |
Prophylaxis - adult |
9,132 |
8,957 |
$570K |
| D0330 |
Panoramic radiographic image |
4,727 |
4,670 |
$411K |
| D0210 |
Intraoral - complete series of radiographic images |
1,553 |
1,462 |
$185K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,607 |
1,639 |
$161K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
733 |
546 |
$128K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,997 |
4,868 |
$127K |
| D1208 |
Topical application of fluoride, excluding varnish |
30,920 |
30,251 |
$127K |
| D0272 |
Bitewings - two radiographic images |
26,853 |
26,379 |
$124K |
| D1351 |
Sealant - per tooth |
23,314 |
5,622 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
27,330 |
26,763 |
$103K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,582 |
1,623 |
$96K |
| D0240 |
|
2,447 |
1,806 |
$88K |
| D1330 |
|
32,529 |
31,843 |
$62K |
| D1510 |
|
263 |
227 |
$51K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,623 |
3,517 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
933 |
676 |
$30K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
347 |
229 |
$20K |
| D9999 |
Unspecified adjunctive procedure, by report |
628 |
628 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
908 |
895 |
$12K |
| D2140 |
|
163 |
115 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
2,176 |
2,032 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
238 |
204 |
$2K |
| D3120 |
|
207 |
145 |
$789.87 |
| D0274 |
Bitewings - four radiographic images |
59 |
59 |
$16.00 |
| D9986 |
|
2,152 |
2,076 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
16 |
15 |
$0.00 |