| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
18,077 |
16,937 |
$1.21M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,715 |
2,829 |
$246K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,824 |
2,660 |
$173K |
| D1351 |
Sealant - per tooth |
8,278 |
2,017 |
$65K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,172 |
789 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,524 |
2,253 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
395 |
301 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,847 |
19,531 |
$32K |
| D1120 |
Prophylaxis - child |
14,154 |
13,309 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
508 |
378 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
333 |
280 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
19,552 |
18,246 |
$16K |
| D1110 |
Prophylaxis - adult |
6,739 |
6,283 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
1,060 |
973 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,733 |
17,433 |
$13K |
| D1330 |
|
20,981 |
19,654 |
$9K |
| D0330 |
Panoramic radiographic image |
2,894 |
2,810 |
$9K |
| D0274 |
Bitewings - four radiographic images |
7,026 |
6,565 |
$7K |
| D0272 |
Bitewings - two radiographic images |
7,734 |
7,283 |
$6K |
| D3120 |
|
2,385 |
1,688 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
28 |
28 |
$635.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
18 |
16 |
$404.00 |