| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
33,920 |
29,134 |
$903K |
| D1206 |
Topical application of fluoride varnish |
29,873 |
25,971 |
$674K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,741 |
3,950 |
$656K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,284 |
1,353 |
$641K |
| D0120 |
Periodic oral evaluation - established patient |
23,229 |
22,163 |
$639K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,790 |
9,768 |
$372K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,491 |
2,833 |
$340K |
| D0330 |
Panoramic radiographic image |
6,188 |
5,456 |
$311K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,247 |
1,254 |
$275K |
| D0272 |
Bitewings - two radiographic images |
13,955 |
11,756 |
$252K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,902 |
955 |
$137K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,831 |
2,912 |
$111K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,410 |
6,197 |
$106K |
| D0274 |
Bitewings - four radiographic images |
2,567 |
2,438 |
$87K |
| D0140 |
Limited oral evaluation - problem focused |
1,781 |
1,519 |
$65K |
| D9420 |
|
762 |
681 |
$52K |
| D2330 |
|
660 |
347 |
$47K |
| D1110 |
Prophylaxis - adult |
648 |
531 |
$26K |
| D7240 |
Removal of impacted tooth - completely bony |
98 |
28 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,128 |
1,048 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
185 |
184 |
$8K |
| D2331 |
|
57 |
36 |
$5K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
107 |
38 |
$5K |
| D9222 |
|
39 |
38 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
14 |
$2K |
| D2332 |
|
21 |
12 |
$2K |
| D9610 |
|
36 |
36 |
$0.00 |