| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
35,321 |
34,928 |
$1.29M |
| D0120 |
Periodic oral evaluation - established patient |
29,130 |
28,906 |
$1.16M |
| D1206 |
Topical application of fluoride varnish |
38,708 |
38,288 |
$1.12M |
| D1351 |
Sealant - per tooth |
18,825 |
7,108 |
$534K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,104 |
4,329 |
$478K |
| D1310 |
|
26,597 |
26,319 |
$467K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,742 |
8,547 |
$415K |
| D0230 |
Intraoral - periapical each additional radiographic image |
96,289 |
20,735 |
$385K |
| D0274 |
Bitewings - four radiographic images |
15,092 |
15,013 |
$278K |
| D9999 |
Unspecified adjunctive procedure, by report |
2,654 |
2,537 |
$274K |
| D0220 |
Intraoral - periapical first radiographic image |
22,287 |
21,978 |
$239K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,743 |
3,226 |
$219K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,496 |
2,185 |
$176K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,152 |
4,035 |
$151K |
| D0210 |
Intraoral - complete series of radiographic images |
4,555 |
4,435 |
$147K |
| D0603 |
|
18,568 |
18,385 |
$130K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,954 |
1,954 |
$116K |
| D0330 |
Panoramic radiographic image |
2,816 |
2,815 |
$84K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
993 |
791 |
$72K |
| D0350 |
|
5,074 |
4,506 |
$65K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
497 |
398 |
$54K |
| D1354 |
|
4,503 |
1,278 |
$30K |
| D9430 |
|
803 |
794 |
$25K |
| D0602 |
|
2,942 |
2,884 |
$24K |
| D0272 |
Bitewings - two radiographic images |
2,254 |
2,234 |
$23K |
| D2332 |
|
269 |
194 |
$22K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
222 |
180 |
$20K |
| D1110 |
Prophylaxis - adult |
521 |
502 |
$17K |
| D0999 |
Unspecified diagnostic procedure, by report |
263 |
263 |
$16K |
| D1999 |
|
380 |
378 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
107 |
105 |
$3K |
| D9110 |
|
31 |
30 |
$2K |
| D9993 |
|
13,163 |
12,972 |
$45.00 |
| D1330 |
|
30,726 |
30,322 |
$0.00 |
| D0601 |
|
13 |
13 |
$0.00 |
| D9986 |
|
1,230 |
1,176 |
$0.00 |