| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
29,021 |
28,900 |
$777K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,927 |
2,651 |
$739K |
| D1120 |
Prophylaxis - child |
23,017 |
22,893 |
$648K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,382 |
3,679 |
$514K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,958 |
2,955 |
$503K |
| D1110 |
Prophylaxis - adult |
10,663 |
10,652 |
$425K |
| D1208 |
Topical application of fluoride, excluding varnish |
24,705 |
24,586 |
$420K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,501 |
2,725 |
$384K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,324 |
2,324 |
$286K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,858 |
5,663 |
$266K |
| D0330 |
Panoramic radiographic image |
4,030 |
4,021 |
$244K |
| D0274 |
Bitewings - four radiographic images |
5,968 |
5,961 |
$200K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,517 |
3,501 |
$162K |
| D1351 |
Sealant - per tooth |
5,228 |
1,422 |
$154K |
| D1206 |
Topical application of fluoride varnish |
8,926 |
8,894 |
$153K |
| D0272 |
Bitewings - two radiographic images |
6,161 |
6,151 |
$118K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,289 |
4,735 |
$104K |
| D0220 |
Intraoral - periapical first radiographic image |
5,561 |
5,535 |
$87K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,345 |
1,333 |
$51K |
| D2934 |
|
224 |
107 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
1,022 |
1,010 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
258 |
231 |
$35K |
| D2933 |
|
58 |
25 |
$11K |
| D1510 |
|
15 |
13 |
$3K |
| D1354 |
|
313 |
130 |
$2K |
| D4346 |
|
53 |
53 |
$2K |
| D2330 |
|
25 |
14 |
$2K |
| D4355 |
|
12 |
12 |
$768.48 |
| D9920 |
|
91 |
89 |
$0.00 |
| D1999 |
|
29,406 |
28,326 |
$0.00 |
| D0350 |
|
41 |
34 |
$0.00 |