| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
56,127 |
51,076 |
$2.78M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,454 |
7,309 |
$567K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,501 |
8,424 |
$496K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17,743 |
14,746 |
$288K |
| D0145 |
Oral evaluation for a patient under three years of age |
6,224 |
5,670 |
$235K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,111 |
3,284 |
$229K |
| D0230 |
Intraoral - periapical each additional radiographic image |
109,834 |
58,693 |
$222K |
| D1120 |
Prophylaxis - child |
57,141 |
51,700 |
$215K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,557 |
3,778 |
$202K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,943 |
1,261 |
$193K |
| D1208 |
Topical application of fluoride, excluding varnish |
69,798 |
63,030 |
$169K |
| D1351 |
Sealant - per tooth |
33,792 |
8,310 |
$164K |
| D1110 |
Prophylaxis - adult |
15,246 |
13,845 |
$120K |
| D0330 |
Panoramic radiographic image |
3,344 |
3,028 |
$113K |
| D0220 |
Intraoral - periapical first radiographic image |
69,174 |
61,666 |
$73K |
| D0272 |
Bitewings - two radiographic images |
28,726 |
26,086 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
4,857 |
4,331 |
$52K |
| D1330 |
|
64,341 |
58,190 |
$51K |
| D0274 |
Bitewings - four radiographic images |
16,116 |
14,608 |
$47K |
| D1354 |
|
2,572 |
779 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
252 |
208 |
$5K |
| D3120 |
|
5,790 |
3,081 |
$4K |
| D2390 |
|
23 |
13 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
81 |
53 |
$2K |
| D0603 |
|
11,775 |
11,282 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
351 |
206 |
$2K |
| D1999 |
|
1,571 |
1,472 |
$2K |
| D2330 |
|
17 |
13 |
$920.93 |
| D0999 |
Unspecified diagnostic procedure, by report |
20 |
20 |
$400.00 |
| D0601 |
|
709 |
684 |
$242.00 |
| D0602 |
|
16 |
16 |
$0.00 |