| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,829 |
13,252 |
$576K |
| D1206 |
Topical application of fluoride varnish |
13,528 |
12,957 |
$444K |
| D1351 |
Sealant - per tooth |
12,035 |
2,607 |
$243K |
| D0120 |
Periodic oral evaluation - established patient |
10,232 |
9,809 |
$240K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,951 |
1,787 |
$142K |
| D9248 |
|
1,510 |
1,385 |
$126K |
| D0272 |
Bitewings - two radiographic images |
6,343 |
6,065 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,379 |
3,241 |
$101K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,080 |
525 |
$76K |
| D0330 |
Panoramic radiographic image |
1,801 |
1,714 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,563 |
888 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,562 |
1,073 |
$56K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,762 |
4,348 |
$54K |
| D0240 |
|
5,042 |
2,519 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,587 |
1,500 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
1,071 |
1,007 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,439 |
1,276 |
$14K |
| D1353 |
|
1,088 |
483 |
$14K |
| D0999 |
Unspecified diagnostic procedure, by report |
326 |
326 |
$10K |
| D9999 |
Unspecified adjunctive procedure, by report |
399 |
398 |
$9K |
| D0603 |
|
5,058 |
4,208 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
424 |
393 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
567 |
507 |
$3K |
| D0602 |
|
1,340 |
1,219 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
44 |
26 |
$2K |
| D1999 |
|
8,631 |
8,076 |
$1K |
| D2330 |
|
17 |
12 |
$958.46 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$699.05 |
| D3120 |
|
57 |
39 |
$678.06 |
| D0601 |
|
306 |
283 |
$258.00 |
| D9986 |
|
26 |
24 |
$0.00 |