| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1330 |
|
28,388 |
23,271 |
$534K |
| D1110 |
Prophylaxis - adult |
9,238 |
7,575 |
$517K |
| D0120 |
Periodic oral evaluation - established patient |
25,192 |
20,704 |
$339K |
| D0330 |
Panoramic radiographic image |
4,223 |
3,581 |
$337K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,471 |
1,305 |
$293K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,864 |
2,946 |
$248K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,822 |
3,793 |
$188K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,038 |
2,168 |
$128K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,786 |
1,976 |
$72K |
| D1351 |
Sealant - per tooth |
18,819 |
4,297 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,392 |
1,966 |
$49K |
| D1120 |
Prophylaxis - child |
18,430 |
15,204 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
27,623 |
22,719 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
2,122 |
1,605 |
$18K |
| D9995 |
|
506 |
378 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,459 |
1,295 |
$10K |
| D9996 |
|
318 |
231 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
14,120 |
11,141 |
$8K |
| D0272 |
Bitewings - two radiographic images |
12,624 |
10,396 |
$7K |
| D1510 |
|
45 |
25 |
$6K |
| D2335 |
|
54 |
37 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
91 |
72 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,153 |
9,012 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
118 |
78 |
$2K |
| D2330 |
|
69 |
27 |
$948.23 |
| D1999 |
|
16 |
16 |
$640.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
13 |
13 |
$260.00 |
| D0240 |
|
390 |
271 |
$155.64 |