| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,363 |
11,180 |
$420K |
| D1110 |
Prophylaxis - adult |
5,065 |
4,988 |
$393K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,916 |
1,768 |
$225K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,470 |
1,246 |
$161K |
| D1120 |
Prophylaxis - child |
7,809 |
7,670 |
$141K |
| D0330 |
Panoramic radiographic image |
1,497 |
1,471 |
$97K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,346 |
1,329 |
$83K |
| D0220 |
Intraoral - periapical first radiographic image |
12,560 |
12,280 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,445 |
1,412 |
$64K |
| D1351 |
Sealant - per tooth |
4,292 |
1,219 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,892 |
12,668 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,908 |
1,780 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
79 |
51 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
810 |
772 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,081 |
11,781 |
$11K |
| D0272 |
Bitewings - two radiographic images |
6,333 |
6,231 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
60 |
60 |
$8K |
| D1330 |
|
9,684 |
9,604 |
$7K |
| D0274 |
Bitewings - four radiographic images |
5,035 |
4,947 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
16 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
76 |
50 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
15 |
15 |
$375.00 |
| D1999 |
|
339 |
325 |
$0.00 |