| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
20,168 |
17,957 |
$449K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,261 |
1,629 |
$251K |
| D1110 |
Prophylaxis - adult |
7,185 |
6,405 |
$244K |
| D1354 |
|
19,244 |
4,096 |
$236K |
| D0274 |
Bitewings - four radiographic images |
8,169 |
7,249 |
$134K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,088 |
1,538 |
$108K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,111 |
606 |
$96K |
| D2335 |
|
1,150 |
421 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,324 |
2,055 |
$89K |
| D1351 |
Sealant - per tooth |
12,294 |
2,846 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,646 |
18,602 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,112 |
19,642 |
$43K |
| D0330 |
Panoramic radiographic image |
2,064 |
1,934 |
$41K |
| D1120 |
Prophylaxis - child |
15,422 |
13,723 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,648 |
911 |
$40K |
| D1330 |
|
22,418 |
19,925 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
1,642 |
1,484 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
22,133 |
19,590 |
$13K |
| D0272 |
Bitewings - two radiographic images |
8,691 |
7,634 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
69 |
69 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,302 |
1,107 |
$7K |
| D2390 |
|
46 |
26 |
$3K |
| D9310 |
|
105 |
99 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
127 |
50 |
$2K |
| D7111 |
|
138 |
69 |
$913.84 |
| D0350 |
|
96 |
94 |
$611.65 |
| D0470 |
|
17 |
13 |
$0.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
24 |
17 |
$0.00 |