| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
20,648 |
18,783 |
$815K |
| D1120 |
Prophylaxis - child |
26,881 |
25,257 |
$770K |
| D0330 |
Panoramic radiographic image |
10,508 |
9,617 |
$711K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,539 |
8,782 |
$619K |
| D0120 |
Periodic oral evaluation - established patient |
38,513 |
35,613 |
$597K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,693 |
2,084 |
$450K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,625 |
2,858 |
$306K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,473 |
7,913 |
$293K |
| D9999 |
Unspecified adjunctive procedure, by report |
3,952 |
3,521 |
$208K |
| D1351 |
Sealant - per tooth |
38,192 |
9,279 |
$172K |
| D1208 |
Topical application of fluoride, excluding varnish |
45,935 |
42,519 |
$148K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,784 |
2,726 |
$125K |
| D0210 |
Intraoral - complete series of radiographic images |
1,121 |
1,024 |
$108K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,154 |
8,218 |
$106K |
| D0220 |
Intraoral - periapical first radiographic image |
26,039 |
24,463 |
$100K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,373 |
1,730 |
$78K |
| D1330 |
|
44,477 |
40,990 |
$55K |
| D1510 |
|
173 |
151 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
3,152 |
2,925 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,070 |
10,992 |
$40K |
| D0274 |
Bitewings - four radiographic images |
16,390 |
14,771 |
$38K |
| D0272 |
Bitewings - two radiographic images |
27,539 |
25,862 |
$36K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,345 |
1,805 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
251 |
245 |
$15K |
| D2335 |
|
55 |
37 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
139 |
113 |
$8K |
| D2931 |
|
33 |
29 |
$7K |
| D0601 |
|
19,658 |
18,209 |
$5K |
| D1999 |
|
2,208 |
2,106 |
$5K |
| D1206 |
Topical application of fluoride varnish |
595 |
592 |
$3K |
| D0603 |
|
12,743 |
11,634 |
$3K |
| D9986 |
|
1,603 |
1,469 |
$2K |
| D0602 |
|
8,931 |
8,177 |
$2K |
| D2950 |
|
27 |
24 |
$1K |
| D2140 |
|
17 |
14 |
$800.08 |
| D0999 |
Unspecified diagnostic procedure, by report |
24 |
24 |
$480.00 |
| D9920 |
|
16 |
15 |
$35.00 |
| D9987 |
|
65 |
61 |
$0.00 |
| D9440 |
|
209 |
200 |
$0.00 |