| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
49,747 |
49,023 |
$775K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18,688 |
10,930 |
$599K |
| D0120 |
Periodic oral evaluation - established patient |
52,246 |
51,552 |
$572K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,327 |
3,430 |
$437K |
| D1208 |
Topical application of fluoride, excluding varnish |
53,851 |
53,075 |
$409K |
| D0220 |
Intraoral - periapical first radiographic image |
63,082 |
61,749 |
$333K |
| D0272 |
Bitewings - two radiographic images |
39,034 |
38,467 |
$316K |
| D0230 |
Intraoral - periapical each additional radiographic image |
65,387 |
58,653 |
$289K |
| D1110 |
Prophylaxis - adult |
10,158 |
10,028 |
$210K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,747 |
4,607 |
$181K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,146 |
2,950 |
$179K |
| D0274 |
Bitewings - four radiographic images |
11,670 |
11,510 |
$153K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,674 |
1,232 |
$124K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,987 |
9,532 |
$85K |
| D1351 |
Sealant - per tooth |
7,775 |
2,844 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,167 |
5,097 |
$63K |
| D0330 |
Panoramic radiographic image |
4,640 |
4,579 |
$58K |
| D1206 |
Topical application of fluoride varnish |
6,097 |
6,024 |
$45K |
| D9248 |
|
1,670 |
1,621 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,061 |
1,041 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,580 |
1,552 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
412 |
311 |
$12K |
| D2933 |
|
313 |
99 |
$10K |
| D3230 |
|
421 |
146 |
$10K |
| D9430 |
|
432 |
431 |
$5K |
| D2390 |
|
76 |
27 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
173 |
169 |
$2K |
| D2330 |
|
59 |
30 |
$901.91 |
| D3120 |
|
44 |
29 |
$275.62 |
| D0601 |
|
5,945 |
5,704 |
$0.00 |
| D0603 |
|
9,589 |
9,306 |
$0.00 |
| D0602 |
|
8,826 |
8,604 |
$0.00 |