| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
7,967 |
7,146 |
$221K |
| D0120 |
Periodic oral evaluation - established patient |
6,931 |
6,751 |
$179K |
| D1120 |
Prophylaxis - child |
8,019 |
7,796 |
$176K |
| D9110 |
|
3,553 |
3,421 |
$162K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,352 |
1,075 |
$156K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,416 |
8,181 |
$156K |
| D1351 |
Sealant - per tooth |
4,014 |
1,001 |
$88K |
| D0140 |
Limited oral evaluation - problem focused |
3,445 |
3,210 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,165 |
562 |
$69K |
| D9999 |
Unspecified adjunctive procedure, by report |
2,123 |
2,069 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
7,156 |
6,874 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,452 |
1,400 |
$56K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,472 |
2,117 |
$52K |
| D0272 |
Bitewings - two radiographic images |
4,004 |
3,885 |
$39K |
| D0240 |
|
4,643 |
2,262 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,815 |
6,539 |
$34K |
| D0274 |
Bitewings - four radiographic images |
2,676 |
2,583 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
130 |
54 |
$19K |
| D0330 |
Panoramic radiographic image |
473 |
445 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
191 |
126 |
$13K |
| D1999 |
|
963 |
866 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
124 |
67 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
55 |
24 |
$4K |
| D1110 |
Prophylaxis - adult |
119 |
110 |
$4K |
| D1206 |
Topical application of fluoride varnish |
871 |
859 |
$4K |
| D1354 |
|
947 |
140 |
$3K |