| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,813 |
9,633 |
$526K |
| D1120 |
Prophylaxis - child |
9,288 |
9,132 |
$372K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,081 |
1,376 |
$243K |
| D1110 |
Prophylaxis - adult |
2,515 |
2,476 |
$228K |
| D9420 |
|
282 |
266 |
$195K |
| D0210 |
Intraoral - complete series of radiographic images |
518 |
517 |
$100K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,220 |
1,080 |
$97K |
| D1351 |
Sealant - per tooth |
5,060 |
1,555 |
$93K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,354 |
2,195 |
$93K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,012 |
723 |
$90K |
| D0272 |
Bitewings - two radiographic images |
6,802 |
6,686 |
$86K |
| D0330 |
Panoramic radiographic image |
806 |
796 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,449 |
1,393 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,623 |
10,388 |
$61K |
| D9920 |
|
686 |
680 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,281 |
1,273 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
11,745 |
11,368 |
$55K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
979 |
268 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,530 |
11,335 |
$44K |
| D0274 |
Bitewings - four radiographic images |
2,275 |
2,237 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
177 |
138 |
$26K |
| D1330 |
|
11,277 |
11,082 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
509 |
508 |
$13K |
| D3120 |
|
551 |
424 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
119 |
51 |
$3K |
| D2330 |
|
24 |
14 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
57 |
57 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
56 |
56 |
$1K |
| D1999 |
|
46 |
46 |
$1K |
| D0240 |
|
228 |
146 |
$983.03 |
| D0602 |
|
222 |
222 |
$361.42 |
| D0270 |
|
59 |
58 |
$9.41 |
| D0603 |
|
114 |
114 |
$5.02 |
| D0601 |
|
325 |
325 |
$0.00 |