| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
20,442 |
20,062 |
$572K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,547 |
4,631 |
$564K |
| D0120 |
Periodic oral evaluation - established patient |
24,260 |
23,843 |
$429K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,566 |
23,159 |
$310K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,328 |
1,657 |
$302K |
| D0272 |
Bitewings - two radiographic images |
19,183 |
18,823 |
$288K |
| D0220 |
Intraoral - periapical first radiographic image |
24,870 |
23,895 |
$248K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,375 |
1,973 |
$245K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,231 |
2,832 |
$226K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,147 |
21,921 |
$213K |
| D1110 |
Prophylaxis - adult |
4,605 |
4,532 |
$146K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,725 |
3,638 |
$116K |
| D1351 |
Sealant - per tooth |
5,031 |
1,565 |
$88K |
| D0274 |
Bitewings - four radiographic images |
3,886 |
3,817 |
$84K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,345 |
822 |
$70K |
| D9248 |
|
1,289 |
1,247 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,165 |
2,989 |
$53K |
| D1206 |
Topical application of fluoride varnish |
2,856 |
2,812 |
$38K |
| D2332 |
|
319 |
194 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
830 |
800 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
165 |
131 |
$7K |
| D2330 |
|
77 |
48 |
$3K |
| D0330 |
Panoramic radiographic image |
51 |
51 |
$3K |
| D9222 |
|
383 |
360 |
$72.97 |
| D0603 |
|
3,286 |
3,173 |
$0.00 |
| D0602 |
|
6,910 |
6,734 |
$0.00 |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
921 |
296 |
$0.00 |
| D0601 |
|
1,201 |
1,182 |
$0.00 |