| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,853 |
11,602 |
$525K |
| D1206 |
Topical application of fluoride varnish |
11,840 |
11,574 |
$409K |
| D0120 |
Periodic oral evaluation - established patient |
8,053 |
7,937 |
$374K |
| D1310 |
|
7,398 |
7,122 |
$232K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,837 |
2,118 |
$184K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,043 |
2,964 |
$176K |
| D0220 |
Intraoral - periapical first radiographic image |
11,452 |
11,125 |
$135K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,732 |
2,523 |
$106K |
| D0274 |
Bitewings - four radiographic images |
4,815 |
4,800 |
$103K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,614 |
9,673 |
$103K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,555 |
1,244 |
$82K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,299 |
1,216 |
$75K |
| D1351 |
Sealant - per tooth |
1,840 |
917 |
$65K |
| D9999 |
Unspecified adjunctive procedure, by report |
684 |
638 |
$55K |
| D0603 |
|
6,059 |
5,885 |
$50K |
| D0272 |
Bitewings - two radiographic images |
2,316 |
2,261 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
433 |
330 |
$25K |
| D1110 |
Prophylaxis - adult |
191 |
191 |
$17K |
| D0350 |
|
2,086 |
1,377 |
$15K |
| D0999 |
Unspecified diagnostic procedure, by report |
222 |
222 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
143 |
129 |
$11K |
| D0602 |
|
1,283 |
1,229 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
286 |
283 |
$10K |
| D0601 |
|
718 |
695 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
60 |
47 |
$7K |
| D0330 |
Panoramic radiographic image |
218 |
218 |
$6K |
| D1354 |
|
959 |
352 |
$6K |
| D9430 |
|
154 |
153 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
24 |
20 |
$2K |
| D1999 |
|
33 |
33 |
$870.00 |
| D9993 |
|
2,201 |
2,106 |
$0.00 |