| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
23,472 |
22,980 |
$610K |
| D0120 |
Periodic oral evaluation - established patient |
22,646 |
22,237 |
$380K |
| D0230 |
Intraoral - periapical each additional radiographic image |
52,402 |
17,086 |
$368K |
| D1208 |
Topical application of fluoride, excluding varnish |
28,919 |
28,346 |
$351K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,751 |
2,657 |
$314K |
| D0220 |
Intraoral - periapical first radiographic image |
19,896 |
19,204 |
$188K |
| D0274 |
Bitewings - four radiographic images |
7,106 |
6,955 |
$123K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,354 |
4,234 |
$122K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,207 |
1,537 |
$117K |
| D1110 |
Prophylaxis - adult |
4,105 |
4,026 |
$106K |
| D0330 |
Panoramic radiographic image |
4,180 |
4,085 |
$105K |
| D0272 |
Bitewings - two radiographic images |
5,984 |
5,869 |
$76K |
| D1351 |
Sealant - per tooth |
3,983 |
1,117 |
$72K |
| D9248 |
|
1,609 |
1,529 |
$69K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,061 |
487 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,481 |
1,415 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
795 |
491 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,669 |
1,585 |
$19K |
| D1354 |
|
657 |
158 |
$12K |
| D1999 |
|
3,538 |
3,408 |
$5K |
| D0340 |
|
182 |
169 |
$928.57 |
| D7111 |
|
16 |
12 |
$861.27 |
| D0145 |
Oral evaluation for a patient under three years of age |
67 |
65 |
$820.74 |
| D0210 |
Intraoral - complete series of radiographic images |
79 |
78 |
$506.00 |
| D1206 |
Topical application of fluoride varnish |
24 |
12 |
$241.60 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
36 |
15 |
$79.06 |
| D0601 |
|
635 |
507 |
$0.00 |
| D9920 |
|
25 |
25 |
$0.00 |
| D0602 |
|
28 |
28 |
$0.00 |