| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
43,577 |
43,146 |
$1.14M |
| D1120 |
Prophylaxis - child |
34,297 |
33,857 |
$957K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,278 |
1,915 |
$909K |
| D1110 |
Prophylaxis - adult |
16,084 |
15,930 |
$624K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,492 |
23,284 |
$399K |
| D1206 |
Topical application of fluoride varnish |
21,838 |
21,542 |
$358K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,703 |
7,508 |
$348K |
| D0274 |
Bitewings - four radiographic images |
8,636 |
8,538 |
$275K |
| D0272 |
Bitewings - two radiographic images |
14,768 |
14,563 |
$256K |
| D0330 |
Panoramic radiographic image |
4,551 |
4,489 |
$209K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,518 |
4,233 |
$199K |
| D0240 |
|
10,612 |
5,379 |
$176K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,383 |
879 |
$147K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,905 |
1,027 |
$124K |
| D1351 |
Sealant - per tooth |
4,421 |
1,329 |
$117K |
| D0160 |
|
947 |
915 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
735 |
491 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
1,336 |
1,308 |
$49K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
466 |
324 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
1,192 |
1,166 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
405 |
394 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,086 |
429 |
$14K |
| D9248 |
|
1,033 |
914 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
145 |
83 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
26 |
$4K |
| D9995 |
|
53 |
47 |
$3K |
| D1510 |
|
19 |
12 |
$3K |
| D4341 |
|
27 |
13 |
$3K |
| D7962 |
|
12 |
12 |
$2K |
| D9610 |
|
47 |
42 |
$2K |
| D4355 |
|
13 |
12 |
$701.44 |