| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,638 |
11,477 |
$374K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,904 |
2,853 |
$239K |
| D0120 |
Periodic oral evaluation - established patient |
8,565 |
8,452 |
$205K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,802 |
1,054 |
$180K |
| D1351 |
Sealant - per tooth |
8,964 |
1,952 |
$171K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,618 |
11,449 |
$165K |
| D3240 |
|
1,261 |
791 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,297 |
1,430 |
$96K |
| D0140 |
Limited oral evaluation - problem focused |
3,445 |
3,313 |
$88K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,258 |
4,786 |
$85K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,688 |
1,096 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,820 |
2,771 |
$64K |
| D9420 |
|
182 |
177 |
$53K |
| D0272 |
Bitewings - two radiographic images |
5,317 |
5,238 |
$43K |
| D9920 |
|
2,445 |
2,267 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
5,585 |
5,477 |
$26K |
| D0601 |
|
2,314 |
2,276 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,022 |
4,984 |
$18K |
| D0330 |
Panoramic radiographic image |
745 |
714 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
312 |
312 |
$12K |
| D0602 |
|
1,265 |
1,252 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
208 |
175 |
$11K |
| D0603 |
|
1,159 |
1,137 |
$10K |
| D0274 |
Bitewings - four radiographic images |
76 |
74 |
$937.35 |
| D1110 |
Prophylaxis - adult |
103 |
96 |
$220.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
159 |
154 |
$128.00 |
| D1999 |
|
1,297 |
1,232 |
$0.00 |
| D3120 |
|
70 |
58 |
$0.00 |