| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,102 |
9,863 |
$478K |
| D1110 |
Prophylaxis - adult |
8,316 |
8,020 |
$428K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,801 |
3,690 |
$339K |
| D0120 |
Periodic oral evaluation - established patient |
15,831 |
15,400 |
$254K |
| D0330 |
Panoramic radiographic image |
2,728 |
2,654 |
$237K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,754 |
2,663 |
$146K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
749 |
571 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,017 |
1,949 |
$78K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
657 |
506 |
$75K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,326 |
875 |
$56K |
| D1351 |
Sealant - per tooth |
4,395 |
1,233 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,832 |
2,606 |
$37K |
| D0274 |
Bitewings - four radiographic images |
8,654 |
8,327 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
212 |
212 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,606 |
17,066 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
728 |
690 |
$13K |
| D1354 |
|
1,260 |
343 |
$12K |
| D1330 |
|
18,660 |
18,084 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
15,684 |
15,136 |
$10K |
| D0272 |
Bitewings - two radiographic images |
8,005 |
7,818 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,007 |
14,469 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
108 |
105 |
$4K |
| D1206 |
Topical application of fluoride varnish |
893 |
868 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
1,807 |
1,639 |
$2K |
| D1999 |
|
2,528 |
2,364 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
38 |
31 |
$1K |
| D3120 |
|
287 |
230 |
$725.65 |
| D2331 |
|
16 |
13 |
$467.30 |
| D2330 |
|
14 |
12 |
$324.01 |