| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,394 |
13,258 |
$576K |
| D1206 |
Topical application of fluoride varnish |
13,936 |
13,791 |
$467K |
| D0120 |
Periodic oral evaluation - established patient |
10,021 |
9,957 |
$459K |
| D1310 |
|
7,177 |
7,049 |
$196K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,003 |
2,967 |
$170K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,465 |
1,840 |
$161K |
| D0220 |
Intraoral - periapical first radiographic image |
13,196 |
12,930 |
$156K |
| D0274 |
Bitewings - four radiographic images |
6,183 |
6,178 |
$133K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,129 |
11,574 |
$128K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,941 |
2,711 |
$115K |
| D1351 |
Sealant - per tooth |
3,076 |
1,356 |
$107K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,297 |
1,014 |
$69K |
| D0145 |
Oral evaluation for a patient under three years of age |
953 |
928 |
$55K |
| D9999 |
Unspecified adjunctive procedure, by report |
626 |
589 |
$51K |
| D0603 |
|
6,049 |
5,975 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
617 |
445 |
$35K |
| D1110 |
Prophylaxis - adult |
338 |
338 |
$30K |
| D0272 |
Bitewings - two radiographic images |
2,194 |
2,165 |
$25K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
178 |
151 |
$21K |
| D0350 |
|
1,958 |
1,284 |
$15K |
| D0330 |
Panoramic radiographic image |
401 |
401 |
$12K |
| D0999 |
Unspecified diagnostic procedure, by report |
196 |
196 |
$12K |
| D0602 |
|
1,197 |
1,174 |
$10K |
| D0601 |
|
771 |
759 |
$7K |
| D1354 |
|
1,478 |
358 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
165 |
163 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
53 |
46 |
$4K |
| D9430 |
|
81 |
81 |
$3K |
| D2335 |
|
21 |
12 |
$2K |
| D2330 |
|
31 |
22 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
22 |
17 |
$2K |
| D1999 |
|
88 |
88 |
$2K |
| D2332 |
|
16 |
13 |
$1K |
| D9993 |
|
2,608 |
2,533 |
$0.00 |