| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,828 |
7,698 |
$370K |
| D1110 |
Prophylaxis - adult |
5,920 |
5,828 |
$368K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,747 |
2,307 |
$229K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
743 |
521 |
$119K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,689 |
13,473 |
$111K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,189 |
2,832 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
12,230 |
12,036 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,511 |
1,491 |
$97K |
| D1351 |
Sealant - per tooth |
7,874 |
2,780 |
$93K |
| D0330 |
Panoramic radiographic image |
2,603 |
2,534 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,464 |
944 |
$43K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
231 |
122 |
$32K |
| D0272 |
Bitewings - two radiographic images |
7,768 |
7,642 |
$27K |
| D1330 |
|
13,881 |
13,662 |
$19K |
| D0274 |
Bitewings - four radiographic images |
5,829 |
5,739 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
15,437 |
14,848 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
175 |
175 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
526 |
522 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,539 |
14,195 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
33 |
33 |
$825.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
83 |
49 |
$709.25 |
| D7140 |
Extraction, erupted tooth or exposed root |
73 |
48 |
$243.76 |
| D9987 |
|
2,094 |
1,930 |
$0.00 |
| D9986 |
|
1,720 |
1,648 |
$0.00 |