| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,830 |
8,811 |
$557K |
| D1120 |
Prophylaxis - child |
12,915 |
12,876 |
$539K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,379 |
2,183 |
$216K |
| D1310 |
|
4,764 |
4,751 |
$215K |
| D0350 |
|
23,008 |
6,221 |
$212K |
| D1206 |
Topical application of fluoride varnish |
11,839 |
11,793 |
$189K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,753 |
4,141 |
$186K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,156 |
2,249 |
$162K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,390 |
2,386 |
$161K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32,915 |
13,709 |
$133K |
| D9993 |
|
2,159 |
2,155 |
$114K |
| D9430 |
|
2,912 |
2,751 |
$92K |
| D1351 |
Sealant - per tooth |
3,337 |
1,230 |
$91K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,218 |
1,214 |
$83K |
| D0272 |
Bitewings - two radiographic images |
7,036 |
7,018 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
6,645 |
6,114 |
$79K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,361 |
862 |
$75K |
| D0603 |
|
3,944 |
3,921 |
$57K |
| D0274 |
Bitewings - four radiographic images |
2,566 |
2,562 |
$54K |
| D0330 |
Panoramic radiographic image |
833 |
824 |
$23K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
186 |
87 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
742 |
742 |
$8K |
| D0601 |
|
501 |
494 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
29 |
12 |
$3K |
| D2330 |
|
15 |
12 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$877.80 |
| D0602 |
|
27 |
27 |
$405.00 |