| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
36,235 |
33,134 |
$1.66M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15,697 |
8,765 |
$1.13M |
| D1110 |
Prophylaxis - adult |
16,883 |
15,256 |
$915K |
| D0330 |
Panoramic radiographic image |
10,096 |
9,168 |
$683K |
| D0120 |
Periodic oral evaluation - established patient |
43,217 |
39,270 |
$644K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,369 |
5,972 |
$401K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,961 |
3,419 |
$293K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,176 |
711 |
$188K |
| D0240 |
|
17,627 |
10,335 |
$169K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,034 |
9,204 |
$168K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,361 |
988 |
$163K |
| D1351 |
Sealant - per tooth |
22,595 |
6,037 |
$141K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
18,675 |
16,431 |
$93K |
| D7111 |
|
1,869 |
1,035 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
3,419 |
3,092 |
$47K |
| D0274 |
Bitewings - four radiographic images |
11,637 |
10,580 |
$41K |
| D0272 |
Bitewings - two radiographic images |
33,945 |
30,891 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
513 |
503 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
38,289 |
34,448 |
$34K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,382 |
1,382 |
$28K |
| D1999 |
|
9,414 |
9,147 |
$22K |
| D1510 |
|
103 |
91 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35,694 |
31,338 |
$16K |
| D9248 |
|
306 |
289 |
$15K |
| D1330 |
|
53,671 |
48,831 |
$15K |
| D1517 |
|
58 |
58 |
$12K |
| D2330 |
|
214 |
125 |
$10K |
| D0999 |
Unspecified diagnostic procedure, by report |
475 |
475 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
636 |
420 |
$9K |
| D2332 |
|
176 |
111 |
$9K |
| D1206 |
Topical application of fluoride varnish |
52,715 |
48,058 |
$7K |
| D2390 |
|
40 |
15 |
$7K |
| D2335 |
|
16 |
12 |
$2K |
| D4346 |
|
32 |
26 |
$580.67 |
| D1208 |
Topical application of fluoride, excluding varnish |
490 |
439 |
$509.89 |
| D3120 |
|
865 |
570 |
$448.45 |
| D0603 |
|
2,405 |
2,378 |
$395.11 |
| D0601 |
|
807 |
773 |
$359.57 |
| D0145 |
Oral evaluation for a patient under three years of age |
32 |
32 |
$195.08 |
| D9310 |
|
82 |
82 |
$78.74 |
| D0602 |
|
410 |
406 |
$3.00 |
| D0270 |
|
86 |
85 |
$0.00 |
| D9420 |
|
14 |
14 |
$0.00 |