| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,757 |
10,677 |
$755K |
| D0272 |
Bitewings - two radiographic images |
11,173 |
11,056 |
$267K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,462 |
1,096 |
$219K |
| D1120 |
Prophylaxis - child |
12,065 |
11,975 |
$214K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,782 |
1,268 |
$188K |
| D1351 |
Sealant - per tooth |
7,393 |
1,674 |
$181K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,950 |
673 |
$175K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,108 |
2,092 |
$174K |
| D1206 |
Topical application of fluoride varnish |
12,614 |
12,501 |
$114K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,696 |
941 |
$102K |
| D2140 |
|
1,706 |
925 |
$102K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,160 |
713 |
$85K |
| D0220 |
Intraoral - periapical first radiographic image |
9,118 |
8,956 |
$84K |
| D0330 |
Panoramic radiographic image |
1,964 |
1,943 |
$65K |
| D9420 |
|
441 |
432 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,219 |
1,190 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,822 |
7,352 |
$41K |
| D1110 |
Prophylaxis - adult |
756 |
749 |
$23K |
| D2332 |
|
292 |
163 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
129 |
85 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
305 |
153 |
$13K |
| D1999 |
|
197 |
160 |
$12K |
| D2330 |
|
89 |
53 |
$8K |
| D2160 |
|
52 |
37 |
$3K |
| D2331 |
|
15 |
13 |
$971.23 |
| D9248 |
|
58 |
57 |
$724.38 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
26 |
$128.29 |