| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12,683 |
12,308 |
$330K |
| D1120 |
Prophylaxis - child |
8,958 |
8,683 |
$296K |
| D1110 |
Prophylaxis - adult |
4,850 |
4,725 |
$224K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,446 |
5,638 |
$223K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,975 |
9,672 |
$193K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,559 |
918 |
$161K |
| D0272 |
Bitewings - two radiographic images |
7,207 |
6,925 |
$137K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,829 |
1,488 |
$136K |
| D0330 |
Panoramic radiographic image |
2,178 |
2,108 |
$119K |
| D1206 |
Topical application of fluoride varnish |
3,361 |
3,238 |
$76K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,324 |
1,142 |
$72K |
| D1351 |
Sealant - per tooth |
2,647 |
910 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
3,903 |
3,658 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
663 |
399 |
$39K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
191 |
101 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
266 |
258 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
221 |
217 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
728 |
603 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
70 |
70 |
$915.00 |