| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12,223 |
11,904 |
$501K |
| D1206 |
Topical application of fluoride varnish |
12,546 |
12,366 |
$417K |
| D1120 |
Prophylaxis - child |
7,712 |
7,613 |
$409K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,315 |
483 |
$320K |
| D1110 |
Prophylaxis - adult |
4,114 |
4,071 |
$300K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,449 |
924 |
$243K |
| D0272 |
Bitewings - two radiographic images |
6,551 |
6,459 |
$241K |
| D0220 |
Intraoral - periapical first radiographic image |
7,154 |
7,009 |
$174K |
| D1351 |
Sealant - per tooth |
3,184 |
880 |
$144K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
494 |
368 |
$125K |
| D0140 |
Limited oral evaluation - problem focused |
1,458 |
1,391 |
$87K |
| D7140 |
Extraction, erupted tooth or exposed root |
392 |
219 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
241 |
164 |
$47K |
| D2140 |
|
322 |
217 |
$40K |
| D0330 |
Panoramic radiographic image |
430 |
427 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,012 |
355 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
292 |
267 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
121 |
116 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
21 |
13 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
53 |
50 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$355.63 |
| D0603 |
|
3,497 |
3,074 |
$0.00 |
| D0601 |
|
3,274 |
3,215 |
$0.00 |
| D0602 |
|
8,160 |
8,001 |
$0.00 |