| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
18,918 |
18,745 |
$781K |
| D9920 |
|
5,170 |
5,011 |
$326K |
| D1110 |
Prophylaxis - adult |
4,657 |
4,603 |
$252K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,003 |
2,001 |
$222K |
| D1120 |
Prophylaxis - child |
18,694 |
18,538 |
$192K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,565 |
714 |
$174K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,312 |
4,278 |
$168K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,113 |
4,599 |
$154K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,756 |
1,868 |
$145K |
| D0330 |
Panoramic radiographic image |
2,421 |
2,395 |
$103K |
| D1351 |
Sealant - per tooth |
8,927 |
2,582 |
$84K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,795 |
22,590 |
$66K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,610 |
1,964 |
$62K |
| D1354 |
|
12,946 |
4,138 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
357 |
355 |
$43K |
| D0272 |
Bitewings - two radiographic images |
15,653 |
15,513 |
$34K |
| D1330 |
|
23,366 |
23,157 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
19,203 |
18,901 |
$25K |
| D7111 |
|
489 |
335 |
$23K |
| D2390 |
|
146 |
67 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,438 |
17,521 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
1,743 |
1,700 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
134 |
121 |
$16K |
| D0274 |
Bitewings - four radiographic images |
4,578 |
4,526 |
$12K |
| D9310 |
|
283 |
281 |
$7K |
| D9999 |
Unspecified adjunctive procedure, by report |
235 |
235 |
$6K |
| D3120 |
|
1,655 |
1,023 |
$5K |
| D2330 |
|
57 |
37 |
$2K |
| D0240 |
|
4,261 |
3,462 |
$782.03 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
16 |
12 |
$637.24 |
| D0999 |
Unspecified diagnostic procedure, by report |
31 |
31 |
$620.00 |
| D0350 |
|
105 |
103 |
$386.10 |
| D0270 |
|
47 |
47 |
$16.92 |
| D1206 |
Topical application of fluoride varnish |
476 |
470 |
$0.00 |
| D9986 |
|
3,033 |
2,852 |
$0.00 |