| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,266 |
4,223 |
$275K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,896 |
2,434 |
$256K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,251 |
861 |
$196K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,450 |
1,003 |
$184K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,446 |
2,422 |
$162K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,229 |
3,063 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,580 |
1,434 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
565 |
560 |
$62K |
| D1510 |
|
160 |
139 |
$59K |
| D0240 |
|
3,771 |
3,456 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,301 |
853 |
$32K |
| D1351 |
Sealant - per tooth |
2,455 |
934 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
1,314 |
1,277 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
3,668 |
3,612 |
$19K |
| D9248 |
|
788 |
754 |
$9K |
| D9999 |
Unspecified adjunctive procedure, by report |
341 |
341 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
103 |
100 |
$6K |
| D1120 |
Prophylaxis - child |
5,911 |
5,864 |
$6K |
| D0999 |
Unspecified diagnostic procedure, by report |
144 |
144 |
$3K |
| D0272 |
Bitewings - two radiographic images |
3,506 |
3,483 |
$2K |
| D1999 |
|
46 |
46 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,587 |
2,904 |
$2K |
| D1110 |
Prophylaxis - adult |
51 |
51 |
$2K |
| D0330 |
Panoramic radiographic image |
237 |
237 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,928 |
5,885 |
$994.90 |
| D2330 |
|
34 |
24 |
$407.31 |
| D3120 |
|
86 |
67 |
$382.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
144 |
120 |
$207.00 |
| D1330 |
|
6,129 |
6,084 |
$123.55 |