| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,122 |
10,675 |
$291K |
| D1206 |
Topical application of fluoride varnish |
12,410 |
11,791 |
$236K |
| D1120 |
Prophylaxis - child |
10,276 |
9,831 |
$232K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,708 |
379 |
$200K |
| D1351 |
Sealant - per tooth |
3,990 |
1,056 |
$88K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,282 |
774 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,415 |
1,302 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,588 |
2,331 |
$52K |
| D0272 |
Bitewings - two radiographic images |
4,396 |
4,230 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
670 |
334 |
$34K |
| D0330 |
Panoramic radiographic image |
817 |
775 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
3,872 |
3,477 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
337 |
175 |
$18K |
| D1110 |
Prophylaxis - adult |
465 |
441 |
$15K |
| D1999 |
|
1,149 |
1,075 |
$14K |
| D0274 |
Bitewings - four radiographic images |
999 |
968 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,769 |
2,758 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
205 |
197 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
27 |
12 |
$3K |
| D1354 |
|
535 |
122 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
36 |
35 |
$400.77 |