| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,947 |
2,911 |
$208K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
764 |
756 |
$80K |
| D1110 |
Prophylaxis - adult |
808 |
805 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,603 |
3,397 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
161 |
119 |
$11K |
| D1330 |
|
3,835 |
3,781 |
$8K |
| D1351 |
Sealant - per tooth |
4,041 |
1,195 |
$7K |
| D0272 |
Bitewings - two radiographic images |
2,773 |
2,734 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,402 |
3,363 |
$5K |
| D1120 |
Prophylaxis - child |
2,818 |
2,765 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
73 |
50 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
334 |
309 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
3,568 |
3,512 |
$3K |
| D0330 |
Panoramic radiographic image |
719 |
712 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
22 |
16 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
22 |
16 |
$2K |
| D1206 |
Topical application of fluoride varnish |
382 |
377 |
$16.42 |