| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
29,258 |
28,717 |
$774K |
| D1120 |
Prophylaxis - child |
30,041 |
29,394 |
$696K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,908 |
3,332 |
$376K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,977 |
20,498 |
$358K |
| D1351 |
Sealant - per tooth |
11,569 |
3,126 |
$251K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,552 |
6,323 |
$251K |
| D9999 |
Unspecified adjunctive procedure, by report |
8,109 |
7,913 |
$237K |
| D1206 |
Topical application of fluoride varnish |
10,251 |
10,069 |
$237K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,847 |
881 |
$200K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,676 |
2,481 |
$192K |
| D1110 |
Prophylaxis - adult |
4,960 |
4,856 |
$191K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,314 |
1,876 |
$177K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,371 |
7,462 |
$173K |
| D0272 |
Bitewings - two radiographic images |
16,936 |
16,495 |
$166K |
| D0330 |
Panoramic radiographic image |
3,507 |
3,399 |
$127K |
| D0220 |
Intraoral - periapical first radiographic image |
15,442 |
15,005 |
$123K |
| D0140 |
Limited oral evaluation - problem focused |
3,780 |
3,640 |
$78K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,083 |
500 |
$76K |
| D0240 |
|
9,172 |
4,484 |
$76K |
| D9248 |
|
1,307 |
1,246 |
$68K |
| D1999 |
|
4,007 |
3,768 |
$44K |
| D9630 |
|
720 |
719 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,692 |
12,526 |
$31K |
| D9920 |
|
1,052 |
1,009 |
$24K |
| D2331 |
|
81 |
43 |
$5K |
| D1354 |
|
825 |
364 |
$2K |
| D2330 |
|
23 |
13 |
$1K |