| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0240 |
|
10,132 |
8,431 |
$457K |
| D1110 |
Prophylaxis - adult |
5,022 |
4,941 |
$381K |
| D1120 |
Prophylaxis - child |
12,191 |
12,029 |
$220K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,700 |
1,437 |
$214K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,504 |
2,987 |
$193K |
| D0120 |
Periodic oral evaluation - established patient |
15,880 |
15,653 |
$142K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,258 |
2,598 |
$124K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,599 |
8,545 |
$84K |
| D0220 |
Intraoral - periapical first radiographic image |
11,499 |
11,189 |
$47K |
| D1351 |
Sealant - per tooth |
4,206 |
1,649 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
963 |
673 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
848 |
833 |
$29K |
| D9920 |
|
999 |
869 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
1,056 |
1,017 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,389 |
17,146 |
$12K |
| D0272 |
Bitewings - two radiographic images |
11,589 |
11,435 |
$6K |
| D1330 |
|
17,237 |
16,993 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
14 |
$2K |
| D0330 |
Panoramic radiographic image |
259 |
246 |
$2K |
| D0274 |
Bitewings - four radiographic images |
4,673 |
4,593 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$756.88 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
828 |
795 |
$582.53 |
| D9986 |
|
1,055 |
970 |
$0.00 |
| D3120 |
|
14 |
12 |
$0.00 |