| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
32,834 |
32,521 |
$882K |
| D0120 |
Periodic oral evaluation - established patient |
38,037 |
37,638 |
$724K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,292 |
7,154 |
$692K |
| D9630 |
|
18,156 |
17,955 |
$494K |
| D1206 |
Topical application of fluoride varnish |
32,864 |
32,558 |
$481K |
| D0274 |
Bitewings - four radiographic images |
14,571 |
14,398 |
$404K |
| D1351 |
Sealant - per tooth |
12,374 |
5,360 |
$356K |
| D0272 |
Bitewings - two radiographic images |
17,032 |
16,854 |
$312K |
| D1110 |
Prophylaxis - adult |
11,643 |
11,480 |
$308K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,914 |
1,549 |
$298K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,557 |
3,553 |
$255K |
| D7240 |
Removal of impacted tooth - completely bony |
582 |
362 |
$243K |
| D0240 |
|
16,749 |
11,934 |
$231K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,656 |
6,590 |
$198K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,125 |
8,477 |
$168K |
| D0220 |
Intraoral - periapical first radiographic image |
14,691 |
14,441 |
$167K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,076 |
11,033 |
$163K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,452 |
1,897 |
$154K |
| D0330 |
Panoramic radiographic image |
3,536 |
3,502 |
$149K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,315 |
1,126 |
$128K |
| D0210 |
Intraoral - complete series of radiographic images |
3,538 |
3,371 |
$111K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,728 |
7,605 |
$109K |
| D0140 |
Limited oral evaluation - problem focused |
2,604 |
2,555 |
$55K |
| D9920 |
|
974 |
939 |
$41K |
| D9222 |
|
424 |
422 |
$38K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
396 |
394 |
$36K |
| D7111 |
|
710 |
486 |
$29K |
| D9999 |
Unspecified adjunctive procedure, by report |
39 |
37 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
66 |
39 |
$5K |
| D7230 |
|
15 |
15 |
$5K |
| D9612 |
|
30 |
30 |
$3K |
| D2332 |
|
29 |
25 |
$2K |
| D9610 |
|
34 |
34 |
$2K |
| D1354 |
|
106 |
43 |
$1K |
| D3120 |
|
17 |
16 |
$35.00 |
| D1999 |
|
463 |
441 |
$0.02 |
| D9986 |
|
13 |
13 |
$0.00 |