| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,803 |
11,353 |
$277K |
| D1120 |
Prophylaxis - child |
7,581 |
7,296 |
$275K |
| D1110 |
Prophylaxis - adult |
5,261 |
5,062 |
$254K |
| D1206 |
Topical application of fluoride varnish |
10,930 |
10,501 |
$244K |
| D1351 |
Sealant - per tooth |
7,525 |
1,206 |
$222K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,395 |
719 |
$203K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,903 |
1,012 |
$148K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,643 |
921 |
$146K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,250 |
667 |
$131K |
| D1354 |
|
1,583 |
566 |
$100K |
| D0330 |
Panoramic radiographic image |
1,778 |
1,703 |
$87K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,497 |
2,155 |
$72K |
| D0272 |
Bitewings - two radiographic images |
3,078 |
2,950 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,122 |
729 |
$69K |
| D0274 |
Bitewings - four radiographic images |
1,624 |
1,563 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,566 |
2,923 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,791 |
3,587 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,026 |
990 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
945 |
905 |
$34K |
| D9920 |
|
666 |
588 |
$31K |
| D1510 |
|
226 |
163 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
1,286 |
988 |
$30K |
| D9248 |
|
242 |
222 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
143 |
91 |
$18K |