| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
41,363 |
37,593 |
$2.02M |
| D1206 |
Topical application of fluoride varnish |
38,460 |
35,458 |
$1.80M |
| D0120 |
Periodic oral evaluation - established patient |
35,626 |
32,674 |
$1.02M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,532 |
6,159 |
$542K |
| D1351 |
Sealant - per tooth |
27,392 |
5,831 |
$530K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,874 |
1,585 |
$357K |
| D0272 |
Bitewings - two radiographic images |
19,342 |
17,418 |
$340K |
| D0220 |
Intraoral - periapical first radiographic image |
22,686 |
20,333 |
$299K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,705 |
8,628 |
$266K |
| D0230 |
Intraoral - periapical each additional radiographic image |
49,398 |
22,819 |
$265K |
| D1110 |
Prophylaxis - adult |
5,631 |
5,277 |
$248K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
6,242 |
1,263 |
$242K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,150 |
4,039 |
$241K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,453 |
9,656 |
$176K |
| D0274 |
Bitewings - four radiographic images |
8,413 |
7,607 |
$170K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,378 |
2,049 |
$161K |
| D0330 |
Panoramic radiographic image |
3,589 |
3,205 |
$114K |
| D0140 |
Limited oral evaluation - problem focused |
3,534 |
3,232 |
$103K |
| D9222 |
|
1,621 |
1,158 |
$84K |
| D9310 |
|
1,866 |
1,339 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,634 |
5,555 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
535 |
333 |
$28K |
| D0999 |
Unspecified diagnostic procedure, by report |
818 |
818 |
$25K |
| D1354 |
|
2,802 |
974 |
$23K |
| D9999 |
Unspecified adjunctive procedure, by report |
826 |
826 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,146 |
1,018 |
$20K |
| D9248 |
|
378 |
232 |
$19K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
345 |
173 |
$18K |
| D0270 |
|
1,882 |
1,752 |
$18K |
| D0170 |
|
685 |
570 |
$9K |
| D0603 |
|
3,519 |
3,321 |
$9K |
| D9612 |
|
769 |
522 |
$8K |
| D2929 |
|
55 |
16 |
$6K |
| D1999 |
|
228 |
227 |
$3K |
| D2330 |
|
33 |
13 |
$1K |
| D1353 |
|
134 |
37 |
$1K |
| D3120 |
|
178 |
106 |
$656.00 |
| D0191 |
|
359 |
205 |
$366.54 |
| D9210 |
|
283 |
125 |
$30.75 |
| D9215 |
|
96 |
84 |
$18.45 |
| D1330 |
|
5,325 |
3,929 |
$0.00 |