| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
24,158 |
23,586 |
$580K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,511 |
4,768 |
$520K |
| D2929 |
|
2,184 |
391 |
$516K |
| D1120 |
Prophylaxis - child |
21,440 |
20,920 |
$467K |
| D1206 |
Topical application of fluoride varnish |
22,347 |
21,813 |
$389K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,997 |
2,769 |
$314K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,953 |
3,323 |
$302K |
| D1351 |
Sealant - per tooth |
12,316 |
3,594 |
$254K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,375 |
9,026 |
$208K |
| D1110 |
Prophylaxis - adult |
5,029 |
4,884 |
$175K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,725 |
342 |
$174K |
| D9920 |
|
4,899 |
4,680 |
$133K |
| D0330 |
Panoramic radiographic image |
3,527 |
3,420 |
$124K |
| D9999 |
Unspecified adjunctive procedure, by report |
3,764 |
3,716 |
$101K |
| D0272 |
Bitewings - two radiographic images |
10,403 |
10,167 |
$99K |
| D0140 |
Limited oral evaluation - problem focused |
4,626 |
4,061 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,337 |
2,249 |
$89K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,260 |
995 |
$86K |
| D0220 |
Intraoral - periapical first radiographic image |
6,978 |
6,551 |
$52K |
| D0274 |
Bitewings - four radiographic images |
3,746 |
3,633 |
$48K |
| D1999 |
|
2,930 |
2,457 |
$31K |
| D0240 |
|
3,134 |
1,613 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,757 |
3,472 |
$18K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
194 |
78 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,158 |
1,116 |
$15K |
| D7961 |
|
215 |
153 |
$13K |
| D7962 |
|
142 |
118 |
$9K |
| D2330 |
|
55 |
38 |
$4K |
| D7963 |
|
52 |
25 |
$3K |
| D2331 |
|
33 |
26 |
$2K |
| D9630 |
|
13 |
13 |
$585.00 |
| D0270 |
|
59 |
56 |
$237.60 |
| D9420 |
|
181 |
173 |
$0.00 |
| D3120 |
|
13 |
13 |
$0.00 |
| D1330 |
|
32 |
32 |
$0.00 |