| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,510 |
6,477 |
$375K |
| D1120 |
Prophylaxis - child |
8,576 |
8,534 |
$335K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,098 |
1,864 |
$261K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33,454 |
7,484 |
$151K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,563 |
8,521 |
$125K |
| D1310 |
|
2,436 |
2,419 |
$110K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,946 |
1,897 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,205 |
1,205 |
$74K |
| D9993 |
|
1,101 |
1,100 |
$69K |
| D0272 |
Bitewings - two radiographic images |
4,818 |
4,795 |
$57K |
| D7140 |
Extraction, erupted tooth or exposed root |
931 |
483 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,596 |
1,587 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
638 |
364 |
$32K |
| D0603 |
|
2,085 |
2,074 |
$31K |
| D0145 |
Oral evaluation for a patient under three years of age |
432 |
432 |
$24K |
| D1351 |
Sealant - per tooth |
705 |
232 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,248 |
1,235 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
157 |
105 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
185 |
185 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
42 |
25 |
$4K |
| D0601 |
|
189 |
189 |
$3K |
| D9430 |
|
78 |
76 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
24 |
13 |
$2K |
| D0350 |
|
209 |
109 |
$2K |
| D0602 |
|
25 |
25 |
$375.00 |
| D9985 |
|
2,445 |
2,416 |
$0.00 |
| D1330 |
|
24 |
24 |
$0.00 |