| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,616 |
7,405 |
$212K |
| D1120 |
Prophylaxis - child |
5,985 |
5,815 |
$209K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,307 |
1,278 |
$180K |
| D1110 |
Prophylaxis - adult |
2,617 |
2,533 |
$138K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,022 |
7,809 |
$114K |
| D1351 |
Sealant - per tooth |
4,536 |
588 |
$113K |
| D0272 |
Bitewings - two radiographic images |
3,045 |
2,955 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
625 |
319 |
$55K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
393 |
164 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
4,074 |
3,910 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,859 |
3,686 |
$42K |
| D0330 |
Panoramic radiographic image |
581 |
552 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
765 |
732 |
$24K |
| D0274 |
Bitewings - four radiographic images |
519 |
505 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
174 |
96 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
244 |
240 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
292 |
285 |
$5K |
| D1206 |
Topical application of fluoride varnish |
147 |
139 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
12 |
$2K |
| D0602 |
|
9,879 |
9,530 |
$0.00 |