| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
21,246 |
20,659 |
$933K |
| D1206 |
Topical application of fluoride varnish |
24,469 |
23,801 |
$859K |
| D1351 |
Sealant - per tooth |
22,028 |
5,373 |
$458K |
| D0120 |
Periodic oral evaluation - established patient |
17,708 |
17,218 |
$431K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,185 |
2,294 |
$312K |
| D0272 |
Bitewings - two radiographic images |
14,716 |
14,260 |
$253K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,238 |
1,982 |
$238K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,186 |
6,060 |
$199K |
| D9248 |
|
2,244 |
1,951 |
$175K |
| D0330 |
Panoramic radiographic image |
4,004 |
3,883 |
$153K |
| D0274 |
Bitewings - four radiographic images |
6,064 |
5,887 |
$134K |
| D1110 |
Prophylaxis - adult |
2,960 |
2,897 |
$125K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,547 |
1,952 |
$123K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,731 |
7,921 |
$111K |
| D2140 |
|
1,678 |
994 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
1,778 |
1,650 |
$53K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,267 |
1,265 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
665 |
364 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,882 |
2,449 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,357 |
2,226 |
$26K |
| D0603 |
|
13,402 |
12,645 |
$21K |
| D0999 |
Unspecified diagnostic procedure, by report |
658 |
658 |
$20K |
| D1353 |
|
1,136 |
567 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
396 |
249 |
$15K |
| D2929 |
|
63 |
16 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
193 |
106 |
$7K |
| D0601 |
|
1,772 |
1,738 |
$5K |
| D0240 |
|
301 |
285 |
$4K |
| D9420 |
|
91 |
85 |
$3K |
| D2160 |
|
38 |
26 |
$3K |
| D9440 |
|
48 |
39 |
$2K |
| D0602 |
|
1,811 |
1,756 |
$2K |
| D2331 |
|
18 |
12 |
$1K |
| D1999 |
|
237 |
231 |
$1K |
| D3120 |
|
65 |
41 |
$771.30 |
| D1208 |
Topical application of fluoride, excluding varnish |
46 |
45 |
$430.08 |
| D9310 |
|
15 |
14 |
$360.00 |
| D9986 |
|
157 |
149 |
$0.00 |
| D9215 |
|
93 |
89 |
$0.00 |