| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
91,540 |
89,284 |
$2.37M |
| D1120 |
Prophylaxis - child |
68,887 |
66,783 |
$1.86M |
| D1351 |
Sealant - per tooth |
65,481 |
17,687 |
$1.82M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,472 |
10,678 |
$1.80M |
| D1208 |
Topical application of fluoride, excluding varnish |
98,861 |
95,976 |
$1.63M |
| D1110 |
Prophylaxis - adult |
32,381 |
31,570 |
$1.23M |
| D7140 |
Extraction, erupted tooth or exposed root |
16,147 |
9,208 |
$996K |
| D0330 |
Panoramic radiographic image |
11,771 |
11,320 |
$660K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,357 |
6,555 |
$643K |
| D0272 |
Bitewings - two radiographic images |
33,801 |
32,662 |
$610K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,227 |
12,412 |
$607K |
| D0274 |
Bitewings - four radiographic images |
17,861 |
17,420 |
$566K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,507 |
8,834 |
$387K |
| D0220 |
Intraoral - periapical first radiographic image |
23,789 |
22,198 |
$343K |
| D0140 |
Limited oral evaluation - problem focused |
7,466 |
7,160 |
$273K |
| D7111 |
|
4,708 |
2,566 |
$232K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,216 |
12,981 |
$197K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,250 |
932 |
$171K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,413 |
1,129 |
$169K |
| D0240 |
|
7,207 |
3,593 |
$119K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
948 |
741 |
$76K |
| D1510 |
|
407 |
327 |
$72K |
| D2330 |
|
160 |
95 |
$8K |
| D9986 |
|
61 |
61 |
$0.00 |