| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
37,243 |
36,544 |
$973K |
| D1206 |
Topical application of fluoride varnish |
37,908 |
37,108 |
$712K |
| D1120 |
Prophylaxis - child |
30,053 |
29,523 |
$712K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,537 |
906 |
$638K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,330 |
3,188 |
$441K |
| D1110 |
Prophylaxis - adult |
7,493 |
7,297 |
$290K |
| D9999 |
Unspecified adjunctive procedure, by report |
8,852 |
8,596 |
$262K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,209 |
2,261 |
$235K |
| D0272 |
Bitewings - two radiographic images |
21,478 |
21,091 |
$216K |
| D1351 |
Sealant - per tooth |
8,980 |
2,338 |
$185K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,315 |
1,716 |
$183K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,879 |
6,442 |
$145K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,239 |
3,122 |
$132K |
| D2929 |
|
448 |
131 |
$113K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,000 |
326 |
$94K |
| D0220 |
Intraoral - periapical first radiographic image |
10,521 |
10,256 |
$85K |
| D0274 |
Bitewings - four radiographic images |
5,491 |
5,301 |
$71K |
| D1999 |
|
4,427 |
4,136 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
2,466 |
2,391 |
$52K |
| D0330 |
Panoramic radiographic image |
931 |
920 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,955 |
5,779 |
$30K |
| D9248 |
|
583 |
555 |
$29K |
| D0240 |
|
2,691 |
1,345 |
$23K |