| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
20,385 |
19,561 |
$881K |
| D1206 |
Topical application of fluoride varnish |
21,922 |
20,999 |
$751K |
| D0120 |
Periodic oral evaluation - established patient |
15,879 |
15,169 |
$386K |
| D1351 |
Sealant - per tooth |
14,036 |
3,366 |
$296K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,188 |
1,988 |
$283K |
| D0272 |
Bitewings - two radiographic images |
12,978 |
12,318 |
$218K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,077 |
1,687 |
$180K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,103 |
4,935 |
$161K |
| D9248 |
|
1,542 |
1,409 |
$129K |
| D9999 |
Unspecified adjunctive procedure, by report |
2,855 |
2,855 |
$123K |
| D0330 |
Panoramic radiographic image |
2,965 |
2,838 |
$114K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,017 |
1,656 |
$105K |
| D2140 |
|
1,740 |
1,069 |
$79K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,811 |
5,368 |
$78K |
| D0274 |
Bitewings - four radiographic images |
3,540 |
3,373 |
$78K |
| D0140 |
Limited oral evaluation - problem focused |
1,474 |
1,369 |
$44K |
| D1110 |
Prophylaxis - adult |
987 |
921 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,878 |
2,710 |
$36K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
781 |
384 |
$29K |
| D0603 |
|
13,822 |
12,518 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
558 |
275 |
$27K |
| D2929 |
|
336 |
69 |
$24K |
| D0240 |
|
1,919 |
1,390 |
$24K |
| D0999 |
Unspecified diagnostic procedure, by report |
667 |
667 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,690 |
1,393 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
311 |
164 |
$10K |
| D9993 |
|
358 |
357 |
$10K |
| D1353 |
|
633 |
287 |
$8K |
| D9420 |
|
275 |
199 |
$7K |
| D0602 |
|
3,735 |
3,267 |
$5K |
| D2933 |
|
46 |
12 |
$5K |
| D9310 |
|
63 |
56 |
$2K |
| D0601 |
|
645 |
610 |
$2K |
| D1999 |
|
313 |
300 |
$2K |
| D1510 |
|
15 |
13 |
$1K |
| D9440 |
|
23 |
19 |
$900.00 |
| D9215 |
|
74 |
61 |
$12.30 |
| D9986 |
|
711 |
705 |
$0.00 |