| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
18,659 |
18,640 |
$1.05M |
| D1110 |
Prophylaxis - adult |
5,517 |
5,505 |
$503K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,710 |
3,737 |
$443K |
| D0330 |
Panoramic radiographic image |
2,879 |
2,879 |
$260K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,854 |
897 |
$204K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,254 |
5,248 |
$192K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,081 |
1,721 |
$138K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,938 |
1,113 |
$78K |
| D0210 |
Intraoral - complete series of radiographic images |
385 |
385 |
$69K |
| D0140 |
Limited oral evaluation - problem focused |
1,671 |
1,643 |
$42K |
| D9420 |
|
524 |
523 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
20,634 |
20,606 |
$36K |
| D0274 |
Bitewings - four radiographic images |
4,695 |
4,683 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
147 |
136 |
$14K |
| D1351 |
Sealant - per tooth |
21,145 |
4,729 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,202 |
6,740 |
$4K |
| D2332 |
|
17 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
2,824 |
2,793 |
$260.92 |
| D0272 |
Bitewings - two radiographic images |
17,543 |
17,525 |
$15.87 |
| D1208 |
Topical application of fluoride, excluding varnish |
131 |
130 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,467 |
569 |
$0.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
12 |
12 |
$0.00 |
| D0240 |
|
7,500 |
3,811 |
$-72.19 |
| D1999 |
|
3,043 |
3,031 |
$-77.83 |
| D1206 |
Topical application of fluoride varnish |
23,754 |
23,723 |
$-683.06 |