| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
22,730 |
22,490 |
$1.41M |
| D1110 |
Prophylaxis - adult |
12,130 |
12,040 |
$787K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,570 |
4,815 |
$472K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,690 |
3,395 |
$207K |
| D0120 |
Periodic oral evaluation - established patient |
32,087 |
31,809 |
$169K |
| D1208 |
Topical application of fluoride, excluding varnish |
34,467 |
34,144 |
$144K |
| D0330 |
Panoramic radiographic image |
2,213 |
2,206 |
$130K |
| D7111 |
|
2,003 |
1,347 |
$129K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,335 |
3,184 |
$127K |
| D0210 |
Intraoral - complete series of radiographic images |
1,264 |
1,250 |
$99K |
| D1330 |
|
34,491 |
34,169 |
$95K |
| D0272 |
Bitewings - two radiographic images |
29,962 |
29,699 |
$92K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
509 |
378 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,700 |
1,671 |
$79K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32,368 |
31,404 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
33,188 |
32,767 |
$75K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
487 |
421 |
$54K |
| D1351 |
Sealant - per tooth |
6,534 |
1,931 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,954 |
1,924 |
$27K |
| D9920 |
|
1,990 |
1,917 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
498 |
322 |
$15K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
185 |
142 |
$2K |
| D1999 |
|
135 |
134 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
101 |
100 |
$471.48 |
| D9999 |
Unspecified adjunctive procedure, by report |
13 |
13 |
$325.00 |
| D0274 |
Bitewings - four radiographic images |
43 |
43 |
$144.48 |