| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,629 |
10,542 |
$422K |
| D1110 |
Prophylaxis - adult |
2,581 |
2,556 |
$142K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,314 |
1,589 |
$116K |
| D1120 |
Prophylaxis - child |
8,529 |
8,464 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
726 |
723 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,781 |
1,703 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
755 |
586 |
$28K |
| D0330 |
Panoramic radiographic image |
630 |
624 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
186 |
159 |
$22K |
| D0145 |
Oral evaluation for a patient under three years of age |
540 |
535 |
$18K |
| D7111 |
|
1,105 |
790 |
$16K |
| D9310 |
|
586 |
578 |
$14K |
| D1351 |
Sealant - per tooth |
1,547 |
501 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
319 |
314 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
38 |
25 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,073 |
11,975 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
881 |
873 |
$1K |
| D0272 |
Bitewings - two radiographic images |
3,815 |
3,778 |
$904.49 |
| D0240 |
|
237 |
231 |
$839.95 |
| D1330 |
|
7,663 |
7,612 |
$467.00 |
| D0274 |
Bitewings - four radiographic images |
1,205 |
1,193 |
$375.01 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
17 |
12 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
14 |
$0.00 |