| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
20,505 |
19,918 |
$531K |
| D1120 |
Prophylaxis - child |
17,282 |
16,802 |
$470K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,348 |
1,773 |
$354K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,234 |
16,763 |
$283K |
| D1110 |
Prophylaxis - adult |
4,919 |
4,787 |
$188K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,841 |
3,598 |
$169K |
| D0272 |
Bitewings - two radiographic images |
7,900 |
7,711 |
$144K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
989 |
184 |
$129K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,081 |
4,209 |
$108K |
| D0220 |
Intraoral - periapical first radiographic image |
7,245 |
6,819 |
$106K |
| D1206 |
Topical application of fluoride varnish |
4,672 |
4,550 |
$74K |
| D0330 |
Panoramic radiographic image |
1,072 |
1,040 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,263 |
1,230 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
671 |
521 |
$53K |
| D9420 |
|
382 |
343 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,072 |
1,040 |
$40K |
| D1351 |
Sealant - per tooth |
683 |
230 |
$19K |
| D0240 |
|
1,146 |
718 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
199 |
101 |
$12K |
| D0274 |
Bitewings - four radiographic images |
230 |
222 |
$7K |
| D2330 |
|
96 |
40 |
$6K |
| D2332 |
|
25 |
12 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$2K |