| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
27,547 |
26,772 |
$1.07M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,729 |
6,193 |
$563K |
| D1110 |
Prophylaxis - adult |
9,329 |
9,021 |
$545K |
| D9420 |
|
1,482 |
1,447 |
$501K |
| D0330 |
Panoramic radiographic image |
6,274 |
6,027 |
$376K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,205 |
1,858 |
$368K |
| D0230 |
Intraoral - periapical each additional radiographic image |
63,084 |
33,429 |
$269K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,661 |
10,333 |
$251K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,848 |
4,736 |
$245K |
| D0210 |
Intraoral - complete series of radiographic images |
3,040 |
3,038 |
$172K |
| D1206 |
Topical application of fluoride varnish |
23,735 |
23,095 |
$146K |
| D0120 |
Periodic oral evaluation - established patient |
25,826 |
25,101 |
$122K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,300 |
1,497 |
$94K |
| D7111 |
|
2,029 |
1,442 |
$77K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,739 |
10,379 |
$71K |
| D1351 |
Sealant - per tooth |
9,810 |
3,053 |
$66K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,160 |
1,144 |
$61K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,352 |
1,117 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
36,995 |
35,664 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
4,049 |
3,924 |
$42K |
| D1330 |
|
36,981 |
35,883 |
$35K |
| D0274 |
Bitewings - four radiographic images |
9,422 |
9,079 |
$19K |
| D0272 |
Bitewings - two radiographic images |
12,042 |
11,626 |
$14K |
| D2390 |
|
226 |
101 |
$11K |
| D1510 |
|
20 |
12 |
$8K |
| D2330 |
|
205 |
114 |
$6K |
| D8660 |
|
40 |
40 |
$4K |
| D0999 |
Unspecified diagnostic procedure, by report |
86 |
86 |
$2K |
| D2332 |
|
54 |
36 |
$2K |
| D0601 |
|
3,688 |
3,130 |
$1K |
| D9310 |
|
64 |
62 |
$1K |
| D0602 |
|
2,853 |
2,501 |
$883.00 |
| D0603 |
|
2,201 |
1,947 |
$709.00 |
| D3120 |
|
225 |
184 |
$681.06 |
| D0240 |
|
139 |
84 |
$590.24 |
| D1208 |
Topical application of fluoride, excluding varnish |
12,313 |
11,872 |
$440.00 |
| D0350 |
|
118 |
116 |
$217.65 |