| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,515 |
5,385 |
$220K |
| D1110 |
Prophylaxis - adult |
2,026 |
1,976 |
$173K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,538 |
5,261 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
825 |
607 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
369 |
363 |
$19K |
| D0330 |
Panoramic radiographic image |
611 |
609 |
$9K |
| D1120 |
Prophylaxis - child |
3,945 |
3,857 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,971 |
5,832 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
494 |
433 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
29 |
24 |
$6K |
| D1351 |
Sealant - per tooth |
3,996 |
1,280 |
$4K |
| D1330 |
|
6,035 |
5,896 |
$4K |
| D0240 |
|
266 |
163 |
$2K |
| D0272 |
Bitewings - two radiographic images |
3,996 |
3,892 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
5,810 |
5,475 |
$2K |
| D0274 |
Bitewings - four radiographic images |
346 |
345 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
87 |
81 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
26 |
$251.19 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
15 |
12 |
$0.00 |