| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
72,076 |
65,719 |
$1.73M |
| D1120 |
Prophylaxis - child |
51,568 |
47,225 |
$1.31M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,640 |
6,493 |
$1.14M |
| D1206 |
Topical application of fluoride varnish |
75,485 |
68,830 |
$1.13M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,372 |
3,114 |
$1.11M |
| D1110 |
Prophylaxis - adult |
21,243 |
19,355 |
$749K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,986 |
5,892 |
$656K |
| D1351 |
Sealant - per tooth |
23,554 |
6,872 |
$623K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,878 |
13,547 |
$606K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,612 |
4,320 |
$449K |
| D0272 |
Bitewings - two radiographic images |
24,243 |
22,287 |
$413K |
| D0330 |
Panoramic radiographic image |
5,149 |
4,865 |
$278K |
| D0140 |
Limited oral evaluation - problem focused |
7,491 |
6,740 |
$256K |
| D0274 |
Bitewings - four radiographic images |
8,207 |
7,535 |
$247K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,149 |
4,710 |
$211K |
| D9420 |
|
1,501 |
1,373 |
$165K |
| D0240 |
|
8,066 |
4,317 |
$123K |
| D0220 |
Intraoral - periapical first radiographic image |
7,557 |
6,871 |
$106K |
| D2390 |
|
219 |
82 |
$34K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
377 |
234 |
$30K |
| D9248 |
|
319 |
258 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,280 |
743 |
$14K |
| D2332 |
|
109 |
53 |
$9K |
| D1354 |
|
1,292 |
526 |
$9K |
| D2330 |
|
104 |
64 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
56 |
49 |
$2K |
| D9310 |
|
26 |
26 |
$0.00 |