| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
40,005 |
39,390 |
$1.06M |
| D1120 |
Prophylaxis - child |
44,266 |
43,481 |
$1.03M |
| D1208 |
Topical application of fluoride, excluding varnish |
46,219 |
45,395 |
$901K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,079 |
6,587 |
$666K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,262 |
1,867 |
$646K |
| D9630 |
|
14,197 |
13,926 |
$619K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,860 |
5,493 |
$489K |
| D0220 |
Intraoral - periapical first radiographic image |
46,458 |
45,209 |
$374K |
| D1351 |
Sealant - per tooth |
15,711 |
4,685 |
$373K |
| D9999 |
Unspecified adjunctive procedure, by report |
11,236 |
11,028 |
$337K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,151 |
7,935 |
$318K |
| D0272 |
Bitewings - two radiographic images |
30,506 |
29,906 |
$302K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,686 |
12,824 |
$298K |
| D0330 |
Panoramic radiographic image |
8,618 |
8,329 |
$266K |
| D0230 |
Intraoral - periapical each additional radiographic image |
112,776 |
42,864 |
$261K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,272 |
2,486 |
$239K |
| D1110 |
Prophylaxis - adult |
3,572 |
3,499 |
$148K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,046 |
561 |
$103K |
| D0140 |
Limited oral evaluation - problem focused |
4,207 |
4,117 |
$88K |
| D2390 |
|
306 |
115 |
$85K |
| D1999 |
|
4,847 |
4,270 |
$64K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
203 |
160 |
$15K |
| D1354 |
|
1,516 |
490 |
$6K |
| D0274 |
Bitewings - four radiographic images |
325 |
291 |
$3K |
| D7111 |
|
104 |
78 |
$3K |
| D2330 |
|
23 |
13 |
$2K |
| D3230 |
|
24 |
13 |
$2K |
| D0270 |
|
12 |
12 |
$47.52 |
| D0350 |
|
42 |
34 |
$17.92 |