| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,040 |
12,454 |
$349K |
| D1120 |
Prophylaxis - child |
8,560 |
8,168 |
$290K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,418 |
1,937 |
$279K |
| D1110 |
Prophylaxis - adult |
4,755 |
4,580 |
$240K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,785 |
12,260 |
$177K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,311 |
1,438 |
$160K |
| D0272 |
Bitewings - two radiographic images |
5,568 |
5,301 |
$122K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,495 |
4,184 |
$112K |
| D0210 |
Intraoral - complete series of radiographic images |
1,480 |
1,431 |
$95K |
| D0145 |
Oral evaluation for a patient under three years of age |
579 |
563 |
$70K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,305 |
687 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,434 |
1,386 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
3,239 |
3,052 |
$37K |
| D1351 |
Sealant - per tooth |
690 |
234 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,289 |
742 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
77 |
54 |
$10K |
| D0330 |
Panoramic radiographic image |
178 |
167 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
183 |
176 |
$3K |
| D0601 |
|
1,438 |
1,406 |
$0.00 |
| D0602 |
|
7,854 |
7,691 |
$0.00 |
| D0603 |
|
4,539 |
4,448 |
$0.00 |