| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,332 |
11,734 |
$304K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,374 |
1,576 |
$266K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,726 |
2,017 |
$264K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,902 |
13,011 |
$237K |
| D1120 |
Prophylaxis - child |
10,644 |
9,348 |
$201K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,590 |
536 |
$150K |
| D1351 |
Sealant - per tooth |
7,019 |
1,567 |
$123K |
| D1110 |
Prophylaxis - adult |
3,470 |
3,053 |
$119K |
| D0272 |
Bitewings - two radiographic images |
11,932 |
10,440 |
$103K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,876 |
4,165 |
$91K |
| D0220 |
Intraoral - periapical first radiographic image |
11,764 |
10,330 |
$85K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,370 |
655 |
$72K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,069 |
361 |
$65K |
| D0330 |
Panoramic radiographic image |
1,786 |
1,575 |
$53K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,382 |
1,190 |
$31K |
| D1999 |
|
10,020 |
8,321 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
851 |
731 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,764 |
9,683 |
$24K |
| D2330 |
|
292 |
112 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
780 |
659 |
$14K |
| D9920 |
|
937 |
843 |
$12K |
| D2390 |
|
40 |
13 |
$6K |
| D1206 |
Topical application of fluoride varnish |
102 |
102 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
26 |
$3K |
| D0350 |
|
824 |
241 |
$0.00 |