| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,107 |
8,072 |
$493K |
| D1120 |
Prophylaxis - child |
10,173 |
10,130 |
$422K |
| D1310 |
|
4,706 |
4,687 |
$212K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,686 |
1,531 |
$175K |
| D9993 |
|
2,132 |
2,132 |
$136K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,582 |
1,575 |
$104K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,110 |
2,031 |
$83K |
| D1206 |
Topical application of fluoride varnish |
3,547 |
3,533 |
$83K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,991 |
7,207 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,139 |
6,117 |
$70K |
| D1351 |
Sealant - per tooth |
2,205 |
778 |
$69K |
| D0272 |
Bitewings - two radiographic images |
5,520 |
5,495 |
$65K |
| D0145 |
Oral evaluation for a patient under three years of age |
912 |
911 |
$57K |
| D0603 |
|
2,970 |
2,957 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
596 |
462 |
$31K |
| D9430 |
|
733 |
701 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
375 |
255 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,761 |
1,730 |
$21K |
| D0601 |
|
1,325 |
1,320 |
$20K |
| D0274 |
Bitewings - four radiographic images |
367 |
365 |
$8K |
| D0330 |
Panoramic radiographic image |
133 |
133 |
$4K |
| D9920 |
|
27 |
26 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
19 |
13 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
20 |
13 |
$2K |
| D0602 |
|
31 |
31 |
$451.00 |
| D1999 |
|
178 |
178 |
$210.00 |