| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
18,585 |
18,465 |
$534K |
| D1120 |
Prophylaxis - child |
14,345 |
14,254 |
$524K |
| D1351 |
Sealant - per tooth |
17,711 |
7,102 |
$517K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,872 |
2,326 |
$438K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,572 |
20,441 |
$427K |
| D1110 |
Prophylaxis - adult |
8,214 |
8,157 |
$415K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,303 |
2,776 |
$381K |
| D0272 |
Bitewings - two radiographic images |
10,358 |
10,278 |
$224K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,318 |
1,490 |
$176K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,771 |
821 |
$169K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,263 |
4,183 |
$162K |
| D9920 |
|
1,895 |
1,729 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,034 |
2,013 |
$99K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,843 |
1,838 |
$89K |
| D0220 |
Intraoral - periapical first radiographic image |
6,180 |
5,420 |
$78K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
390 |
169 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,242 |
1,978 |
$33K |
| D7111 |
|
301 |
207 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
118 |
87 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
455 |
446 |
$7K |
| D2330 |
|
41 |
27 |
$3K |
| D2332 |
|
22 |
12 |
$3K |
| D0350 |
|
1,709 |
1,042 |
$37.12 |