| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,114 |
10,068 |
$392K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,217 |
2,691 |
$295K |
| D0330 |
Panoramic radiographic image |
2,686 |
2,677 |
$245K |
| D1110 |
Prophylaxis - adult |
2,906 |
2,901 |
$168K |
| D0120 |
Periodic oral evaluation - established patient |
11,715 |
11,659 |
$149K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,042 |
3,514 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,056 |
12,002 |
$61K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
969 |
698 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,096 |
1,094 |
$38K |
| D1351 |
Sealant - per tooth |
3,507 |
1,109 |
$27K |
| D0274 |
Bitewings - four radiographic images |
9,552 |
9,511 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
245 |
206 |
$23K |
| D1330 |
|
12,995 |
12,931 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
679 |
498 |
$17K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
72 |
59 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
758 |
749 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
9,717 |
9,583 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,413 |
8,909 |
$10K |
| D9999 |
Unspecified adjunctive procedure, by report |
199 |
199 |
$5K |
| D1999 |
|
1,018 |
1,004 |
$4K |
| D0999 |
Unspecified diagnostic procedure, by report |
164 |
164 |
$2K |
| D0272 |
Bitewings - two radiographic images |
1,360 |
1,358 |
$830.65 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
27 |
25 |
$256.20 |
| D1206 |
Topical application of fluoride varnish |
483 |
481 |
$91.00 |
| D9986 |
|
18 |
17 |
$0.00 |