| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
27,808 |
26,636 |
$500K |
| D1110 |
Prophylaxis - adult |
13,219 |
12,704 |
$472K |
| D1120 |
Prophylaxis - child |
16,686 |
15,943 |
$441K |
| D1206 |
Topical application of fluoride varnish |
19,798 |
18,846 |
$348K |
| D1351 |
Sealant - per tooth |
14,273 |
2,137 |
$299K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,601 |
831 |
$186K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,768 |
1,714 |
$143K |
| D0330 |
Panoramic radiographic image |
3,838 |
3,592 |
$138K |
| D0272 |
Bitewings - two radiographic images |
7,472 |
7,103 |
$131K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,307 |
4,603 |
$114K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,361 |
766 |
$110K |
| D0210 |
Intraoral - complete series of radiographic images |
2,940 |
2,733 |
$92K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,968 |
1,278 |
$81K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,423 |
842 |
$77K |
| D0274 |
Bitewings - four radiographic images |
2,731 |
2,584 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,266 |
2,178 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
2,068 |
1,980 |
$60K |
| D2940 |
|
1,716 |
1,227 |
$34K |
| D2330 |
|
374 |
227 |
$21K |
| D2331 |
|
271 |
163 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
456 |
363 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,562 |
1,460 |
$14K |
| D2140 |
|
494 |
344 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
669 |
261 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
25 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
452 |
438 |
$924.00 |
| D9420 |
|
45 |
41 |
$0.00 |