| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,844 |
13,608 |
$335K |
| D1120 |
Prophylaxis - child |
14,840 |
14,477 |
$327K |
| D1351 |
Sealant - per tooth |
12,396 |
3,383 |
$263K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,843 |
14,463 |
$240K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,637 |
699 |
$215K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,882 |
1,656 |
$194K |
| D0272 |
Bitewings - two radiographic images |
12,748 |
12,467 |
$127K |
| D9999 |
Unspecified adjunctive procedure, by report |
4,594 |
4,446 |
$125K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,280 |
1,301 |
$121K |
| D0330 |
Panoramic radiographic image |
2,662 |
2,604 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,204 |
2,065 |
$80K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,713 |
3,566 |
$75K |
| D7140 |
Extraction, erupted tooth or exposed root |
988 |
546 |
$56K |
| D1110 |
Prophylaxis - adult |
1,005 |
991 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
4,380 |
4,241 |
$34K |
| D1206 |
Topical application of fluoride varnish |
993 |
986 |
$27K |
| D1999 |
|
1,871 |
1,757 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
1,090 |
1,058 |
$22K |
| D7111 |
|
170 |
119 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,515 |
1,317 |
$3K |
| D0274 |
Bitewings - four radiographic images |
193 |
193 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
23 |
13 |
$2K |
| D9248 |
|
27 |
26 |
$1K |
| D0270 |
|
13 |
13 |
$87.12 |