| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
33,891 |
33,636 |
$943K |
| D1120 |
Prophylaxis - child |
26,204 |
26,065 |
$930K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,494 |
5,640 |
$827K |
| D1110 |
Prophylaxis - adult |
15,690 |
15,386 |
$762K |
| D1208 |
Topical application of fluoride, excluding varnish |
25,907 |
25,755 |
$524K |
| D0272 |
Bitewings - two radiographic images |
20,496 |
20,286 |
$432K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,108 |
4,313 |
$429K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,513 |
9,888 |
$389K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,473 |
5,181 |
$253K |
| D1206 |
Topical application of fluoride varnish |
10,048 |
9,986 |
$249K |
| D0330 |
Panoramic radiographic image |
4,473 |
4,368 |
$223K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,722 |
2,708 |
$125K |
| D1351 |
Sealant - per tooth |
3,872 |
1,445 |
$107K |
| D0220 |
Intraoral - periapical first radiographic image |
7,481 |
7,072 |
$98K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
672 |
549 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
842 |
610 |
$62K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
500 |
408 |
$61K |
| D7111 |
|
747 |
520 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
2,294 |
2,184 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,046 |
1,321 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
228 |
209 |
$10K |
| D0274 |
Bitewings - four radiographic images |
401 |
331 |
$7K |
| D2331 |
|
20 |
13 |
$1K |
| D1999 |
|
830 |
728 |
$35.00 |