| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
32,118 |
31,751 |
$845K |
| D1120 |
Prophylaxis - child |
25,022 |
24,715 |
$674K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,661 |
4,061 |
$622K |
| D1206 |
Topical application of fluoride varnish |
34,411 |
33,970 |
$553K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,551 |
10,014 |
$472K |
| D1110 |
Prophylaxis - adult |
6,797 |
6,710 |
$263K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,104 |
2,443 |
$255K |
| D1351 |
Sealant - per tooth |
8,940 |
3,217 |
$245K |
| D0272 |
Bitewings - two radiographic images |
13,119 |
12,965 |
$234K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
794 |
261 |
$106K |
| D0330 |
Panoramic radiographic image |
1,760 |
1,743 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,955 |
1,911 |
$88K |
| D0140 |
Limited oral evaluation - problem focused |
1,817 |
1,786 |
$69K |
| D0274 |
Bitewings - four radiographic images |
1,508 |
1,498 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
533 |
309 |
$35K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
365 |
126 |
$29K |
| D9420 |
|
351 |
202 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,579 |
1,554 |
$24K |
| D0240 |
|
190 |
105 |
$2K |
| D2330 |
|
29 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
208 |
84 |
$2K |