| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9420 |
|
2,860 |
2,672 |
$1.27M |
| D1120 |
Prophylaxis - child |
14,081 |
13,783 |
$531K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,408 |
2,505 |
$223K |
| D1110 |
Prophylaxis - adult |
3,598 |
3,516 |
$221K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,301 |
8,015 |
$215K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,677 |
5,542 |
$193K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,608 |
1,858 |
$163K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,743 |
3,413 |
$127K |
| D9248 |
|
437 |
435 |
$86K |
| D7962 |
|
748 |
735 |
$82K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,553 |
1,730 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
14,854 |
14,562 |
$58K |
| D1206 |
Topical application of fluoride varnish |
12,822 |
12,494 |
$43K |
| D1351 |
Sealant - per tooth |
6,805 |
1,818 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
2,554 |
2,452 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,106 |
2,943 |
$21K |
| D0330 |
Panoramic radiographic image |
333 |
330 |
$21K |
| D7961 |
|
201 |
196 |
$21K |
| D2335 |
|
723 |
264 |
$16K |
| D0272 |
Bitewings - two radiographic images |
9,161 |
8,964 |
$15K |
| D1330 |
|
18,516 |
18,111 |
$13K |
| D1510 |
|
24 |
13 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
12,009 |
11,619 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,072 |
544 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
609 |
599 |
$9K |
| D9999 |
Unspecified adjunctive procedure, by report |
347 |
347 |
$8K |
| D2330 |
|
490 |
260 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,949 |
3,905 |
$2K |
| D3120 |
|
956 |
552 |
$2K |
| D0350 |
|
1,749 |
1,712 |
$1K |
| D0240 |
|
25 |
25 |
$41.81 |