| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
19,764 |
19,685 |
$495K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,624 |
4,691 |
$479K |
| D1120 |
Prophylaxis - child |
21,027 |
20,886 |
$471K |
| D1206 |
Topical application of fluoride varnish |
21,206 |
21,059 |
$381K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,844 |
880 |
$365K |
| D1351 |
Sealant - per tooth |
13,467 |
4,027 |
$290K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,578 |
2,125 |
$182K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,998 |
7,533 |
$155K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,744 |
2,678 |
$104K |
| D9999 |
Unspecified adjunctive procedure, by report |
3,546 |
3,501 |
$99K |
| D0330 |
Panoramic radiographic image |
2,422 |
2,403 |
$96K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,751 |
946 |
$92K |
| D0272 |
Bitewings - two radiographic images |
9,032 |
8,928 |
$91K |
| D1999 |
|
4,633 |
4,387 |
$60K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
651 |
347 |
$54K |
| D1110 |
Prophylaxis - adult |
1,282 |
1,272 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
587 |
517 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,356 |
1,337 |
$27K |
| D0240 |
|
1,998 |
997 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,045 |
1,010 |
$8K |
| D0274 |
Bitewings - four radiographic images |
305 |
304 |
$5K |
| D2331 |
|
35 |
25 |
$3K |
| D9992 |
|
28 |
28 |
$405.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
30 |
13 |
$63.99 |