| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
30,434 |
29,992 |
$865K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,759 |
4,645 |
$630K |
| D0120 |
Periodic oral evaluation - established patient |
28,938 |
28,588 |
$583K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,290 |
1,850 |
$507K |
| D0220 |
Intraoral - periapical first radiographic image |
41,967 |
40,782 |
$469K |
| D0274 |
Bitewings - four radiographic images |
16,566 |
16,290 |
$442K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14,962 |
14,554 |
$422K |
| D0230 |
Intraoral - periapical each additional radiographic image |
42,231 |
35,047 |
$401K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,090 |
21,808 |
$330K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,098 |
948 |
$309K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,709 |
2,920 |
$302K |
| D0140 |
Limited oral evaluation - problem focused |
11,156 |
10,686 |
$272K |
| D0272 |
Bitewings - two radiographic images |
14,539 |
14,347 |
$266K |
| D1110 |
Prophylaxis - adult |
8,487 |
8,334 |
$226K |
| D0210 |
Intraoral - complete series of radiographic images |
5,454 |
5,339 |
$226K |
| D1206 |
Topical application of fluoride varnish |
15,075 |
14,837 |
$226K |
| D9243 |
|
953 |
946 |
$197K |
| D1351 |
Sealant - per tooth |
6,128 |
2,373 |
$178K |
| D0330 |
Panoramic radiographic image |
5,232 |
5,100 |
$169K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
304 |
233 |
$136K |
| D7230 |
|
627 |
377 |
$135K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,717 |
6,029 |
$124K |
| D7240 |
Removal of impacted tooth - completely bony |
438 |
234 |
$107K |
| D9239 |
|
946 |
946 |
$80K |
| D3310 |
|
320 |
225 |
$79K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,124 |
684 |
$69K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
557 |
326 |
$64K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
448 |
445 |
$49K |
| D9630 |
|
1,563 |
1,557 |
$45K |
| D2140 |
|
442 |
439 |
$42K |
| D9310 |
|
409 |
383 |
$28K |
| D9222 |
|
323 |
309 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
135 |
114 |
$15K |
| D7111 |
|
138 |
138 |
$9K |
| D0240 |
|
586 |
385 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
92 |
56 |
$7K |
| D0270 |
|
700 |
681 |
$7K |
| D2160 |
|
59 |
57 |
$5K |
| D9248 |
|
133 |
129 |
$4K |
| D2934 |
|
35 |
12 |
$4K |
| D9920 |
|
17 |
14 |
$278.90 |
| D3120 |
|
82 |
63 |
$211.04 |
| D1999 |
|
23 |
18 |
$0.17 |
| D4346 |
|
13 |
13 |
$0.00 |
| D0431 |
|
103 |
101 |
$0.00 |