| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,733 |
11,615 |
$332K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,291 |
2,273 |
$320K |
| D1110 |
Prophylaxis - adult |
5,128 |
5,080 |
$276K |
| D1120 |
Prophylaxis - child |
6,891 |
6,816 |
$248K |
| D1351 |
Sealant - per tooth |
6,982 |
1,394 |
$189K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,073 |
11,950 |
$174K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,082 |
1,251 |
$152K |
| D0274 |
Bitewings - four radiographic images |
4,153 |
4,110 |
$141K |
| D0272 |
Bitewings - two radiographic images |
5,297 |
5,232 |
$122K |
| D0210 |
Intraoral - complete series of radiographic images |
1,754 |
1,744 |
$120K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,177 |
882 |
$112K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,857 |
2,747 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
4,791 |
4,705 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,418 |
4,336 |
$50K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
305 |
205 |
$41K |
| D1354 |
|
366 |
75 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
78 |
58 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
81 |
77 |
$3K |
| D0601 |
|
1,820 |
1,814 |
$0.05 |
| D0603 |
|
2,876 |
2,831 |
$0.03 |
| D0602 |
|
9,554 |
9,474 |
$0.02 |