| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
11,433 |
11,282 |
$865K |
| D0120 |
Periodic oral evaluation - established patient |
31,658 |
31,238 |
$850K |
| D1120 |
Prophylaxis - child |
26,518 |
26,171 |
$668K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,779 |
5,717 |
$307K |
| D9920 |
|
2,570 |
2,485 |
$171K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,445 |
1,710 |
$166K |
| D0330 |
Panoramic radiographic image |
3,741 |
3,714 |
$142K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,331 |
1,294 |
$99K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,055 |
434 |
$82K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,045 |
1,226 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,778 |
1,239 |
$77K |
| D1351 |
Sealant - per tooth |
21,262 |
5,382 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
38,321 |
37,819 |
$60K |
| D9420 |
|
104 |
104 |
$57K |
| D0272 |
Bitewings - two radiographic images |
21,596 |
21,316 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,716 |
1,661 |
$36K |
| D8670 |
Periodic orthodontic treatment visit |
479 |
476 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
10,803 |
10,640 |
$25K |
| D1330 |
|
38,391 |
37,858 |
$23K |
| D0274 |
Bitewings - four radiographic images |
11,322 |
11,175 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
962 |
936 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,325 |
7,734 |
$9K |
| D1206 |
Topical application of fluoride varnish |
727 |
726 |
$8K |
| D8660 |
|
82 |
79 |
$4K |
| D1354 |
|
962 |
331 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
166 |
142 |
$3K |
| D0602 |
|
2,108 |
1,931 |
$2K |
| D0601 |
|
4,570 |
3,914 |
$2K |
| D1999 |
|
25 |
25 |
$1K |
| D0603 |
|
2,016 |
1,819 |
$744.40 |
| D0999 |
Unspecified diagnostic procedure, by report |
30 |
30 |
$600.00 |
| D3120 |
|
34 |
29 |
$160.21 |