| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,928 |
9,609 |
$415K |
| D1110 |
Prophylaxis - adult |
4,433 |
4,295 |
$72K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,533 |
883 |
$62K |
| D0272 |
Bitewings - two radiographic images |
8,266 |
7,993 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,367 |
1,331 |
$60K |
| D0330 |
Panoramic radiographic image |
1,419 |
1,383 |
$58K |
| D1120 |
Prophylaxis - child |
6,827 |
6,606 |
$52K |
| D1351 |
Sealant - per tooth |
7,573 |
1,824 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
744 |
458 |
$20K |
| D1330 |
|
11,200 |
10,856 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
532 |
313 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
189 |
62 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,662 |
6,410 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
117 |
78 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
718 |
686 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
463 |
422 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
2,695 |
2,592 |
$3K |
| D9920 |
|
107 |
99 |
$2K |
| D0274 |
Bitewings - four radiographic images |
1,123 |
1,109 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
31 |
18 |
$252.55 |
| D0999 |
Unspecified diagnostic procedure, by report |
12 |
12 |
$240.00 |
| D0601 |
|
7,365 |
6,940 |
$165.00 |
| D3120 |
|
73 |
50 |
$119.28 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,701 |
1,671 |
$33.67 |
| D0603 |
|
767 |
738 |
$14.50 |
| D0602 |
|
359 |
344 |
$7.00 |
| D9986 |
|
126 |
125 |
$0.00 |
| D9987 |
|
14 |
14 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
4,064 |
3,981 |
$0.00 |