| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
68,062 |
66,848 |
$1.81M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21,032 |
13,185 |
$1.59M |
| D1206 |
Topical application of fluoride varnish |
80,345 |
78,910 |
$1.34M |
| D0120 |
Periodic oral evaluation - established patient |
66,437 |
65,264 |
$1.14M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
25,554 |
23,819 |
$739K |
| D7140 |
Extraction, erupted tooth or exposed root |
10,921 |
6,001 |
$621K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,131 |
1,734 |
$600K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,285 |
6,748 |
$560K |
| D1110 |
Prophylaxis - adult |
14,224 |
13,965 |
$550K |
| D0272 |
Bitewings - two radiographic images |
28,932 |
28,385 |
$475K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16,482 |
16,134 |
$471K |
| D1351 |
Sealant - per tooth |
19,511 |
6,988 |
$460K |
| D0140 |
Limited oral evaluation - problem focused |
7,864 |
7,591 |
$181K |
| D0274 |
Bitewings - four radiographic images |
7,564 |
7,397 |
$168K |
| D0330 |
Panoramic radiographic image |
3,627 |
3,530 |
$151K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,386 |
1,158 |
$140K |
| D0240 |
|
11,887 |
6,347 |
$124K |
| D0220 |
Intraoral - periapical first radiographic image |
11,667 |
11,312 |
$111K |
| D9999 |
Unspecified adjunctive procedure, by report |
893 |
876 |
$106K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,018 |
2,155 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
1,325 |
1,120 |
$42K |
| D2330 |
|
443 |
273 |
$29K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
394 |
219 |
$28K |
| D3120 |
|
1,001 |
806 |
$13K |
| D2332 |
|
125 |
67 |
$13K |
| D1354 |
|
177 |
63 |
$2K |
| D2331 |
|
16 |
14 |
$1K |
| D2940 |
|
28 |
12 |
$825.60 |
| D1999 |
|
40 |
33 |
$0.00 |