| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
21,008 |
20,806 |
$558K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,260 |
2,795 |
$462K |
| D1120 |
Prophylaxis - child |
15,881 |
15,723 |
$438K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,778 |
21,564 |
$369K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,042 |
2,656 |
$329K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,137 |
6,476 |
$321K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,755 |
879 |
$260K |
| D1110 |
Prophylaxis - adult |
6,513 |
6,441 |
$256K |
| D1351 |
Sealant - per tooth |
7,811 |
2,218 |
$220K |
| D0272 |
Bitewings - two radiographic images |
8,187 |
8,098 |
$154K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,015 |
589 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,710 |
1,663 |
$64K |
| D0274 |
Bitewings - four radiographic images |
1,672 |
1,657 |
$55K |
| D0330 |
Panoramic radiographic image |
843 |
842 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,094 |
3,000 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
994 |
982 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,117 |
807 |
$14K |
| D9420 |
|
90 |
90 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
106 |
67 |
$9K |
| D2330 |
|
61 |
37 |
$4K |
| D9248 |
|
14 |
12 |
$2K |
| D7111 |
|
21 |
18 |
$1K |