| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,481 |
12,202 |
$524K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,913 |
2,430 |
$277K |
| D1110 |
Prophylaxis - adult |
3,677 |
3,590 |
$229K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,465 |
5,309 |
$99K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,441 |
9,354 |
$91K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
594 |
423 |
$84K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,056 |
1,394 |
$77K |
| D0330 |
Panoramic radiographic image |
2,380 |
2,348 |
$72K |
| D1206 |
Topical application of fluoride varnish |
11,859 |
11,609 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
10,623 |
10,408 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,189 |
3,899 |
$42K |
| D1351 |
Sealant - per tooth |
4,819 |
1,521 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
805 |
506 |
$26K |
| D7111 |
|
554 |
377 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
210 |
204 |
$23K |
| D0272 |
Bitewings - two radiographic images |
7,089 |
6,947 |
$23K |
| D1330 |
|
16,669 |
16,289 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
1,188 |
1,162 |
$12K |
| D0274 |
Bitewings - four radiographic images |
3,442 |
3,362 |
$11K |
| D9999 |
Unspecified adjunctive procedure, by report |
396 |
396 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
10,536 |
10,230 |
$6K |
| D0999 |
Unspecified diagnostic procedure, by report |
105 |
105 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$1K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
89 |
48 |
$584.15 |
| D0240 |
|
22 |
15 |
$206.77 |
| D9420 |
|
13 |
13 |
$206.77 |
| D0603 |
|
764 |
672 |
$74.00 |
| D0601 |
|
611 |
555 |
$66.00 |
| D0602 |
|
308 |
284 |
$63.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
4,153 |
4,041 |
$17.00 |
| D3120 |
|
13 |
12 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
55 |
55 |
$0.00 |
| D1354 |
|
268 |
56 |
$0.00 |
| D0350 |
|
14 |
13 |
$0.00 |