| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9420 |
|
9,222 |
8,808 |
$5.78M |
| D1510 |
|
2,696 |
1,786 |
$2.08M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
40,309 |
9,446 |
$1.74M |
| D1120 |
Prophylaxis - child |
15,440 |
14,368 |
$1.12M |
| D0140 |
Limited oral evaluation - problem focused |
18,150 |
17,252 |
$721K |
| D0230 |
Intraoral - periapical each additional radiographic image |
45,800 |
18,271 |
$447K |
| D7140 |
Extraction, erupted tooth or exposed root |
19,694 |
7,289 |
$435K |
| D2335 |
|
7,625 |
2,805 |
$425K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,613 |
2,634 |
$308K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,055 |
4,721 |
$296K |
| D0120 |
Periodic oral evaluation - established patient |
13,862 |
12,915 |
$204K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,012 |
1,858 |
$183K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,971 |
6,944 |
$170K |
| D0272 |
Bitewings - two radiographic images |
19,380 |
18,269 |
$148K |
| D1351 |
Sealant - per tooth |
12,967 |
4,086 |
$120K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,647 |
3,482 |
$109K |
| D0330 |
Panoramic radiographic image |
954 |
853 |
$99K |
| D2933 |
|
202 |
72 |
$90K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,245 |
1,165 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
24,242 |
22,783 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,542 |
16,312 |
$10K |
| D1206 |
Topical application of fluoride varnish |
377 |
355 |
$10K |
| D9999 |
Unspecified adjunctive procedure, by report |
276 |
276 |
$6K |
| D2330 |
|
468 |
284 |
$6K |
| D1330 |
|
16,083 |
14,961 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
12 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
68 |
68 |
$1K |
| D1999 |
|
16 |
16 |
$640.00 |
| D3120 |
|
24 |
15 |
$552.00 |
| D7111 |
|
21 |
14 |
$0.00 |