| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
30,161 |
29,659 |
$848K |
| D1120 |
Prophylaxis - child |
20,892 |
20,540 |
$744K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,775 |
3,707 |
$517K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,066 |
3,266 |
$475K |
| D1110 |
Prophylaxis - adult |
8,506 |
8,394 |
$454K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,154 |
1,028 |
$449K |
| D0272 |
Bitewings - two radiographic images |
17,399 |
17,103 |
$368K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,398 |
20,153 |
$293K |
| D0274 |
Bitewings - four radiographic images |
8,152 |
8,047 |
$253K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,968 |
6,249 |
$174K |
| D1206 |
Topical application of fluoride varnish |
9,797 |
9,567 |
$139K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,734 |
1,236 |
$127K |
| D0330 |
Panoramic radiographic image |
3,543 |
3,496 |
$99K |
| D0210 |
Intraoral - complete series of radiographic images |
1,100 |
1,098 |
$76K |
| D1351 |
Sealant - per tooth |
2,508 |
425 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
5,711 |
5,490 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,986 |
3,024 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
391 |
264 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
142 |
76 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
308 |
302 |
$11K |
| D9420 |
|
215 |
211 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
25 |
$450.72 |
| D0603 |
|
35,426 |
34,915 |
$0.00 |