| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,670 |
11,061 |
$291K |
| D1206 |
Topical application of fluoride varnish |
12,481 |
11,783 |
$229K |
| D1120 |
Prophylaxis - child |
10,258 |
9,720 |
$225K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,592 |
346 |
$166K |
| D1351 |
Sealant - per tooth |
6,093 |
1,344 |
$122K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,888 |
1,073 |
$100K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,849 |
2,371 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
966 |
426 |
$44K |
| D0272 |
Bitewings - two radiographic images |
4,334 |
4,116 |
$41K |
| D1110 |
Prophylaxis - adult |
1,173 |
1,078 |
$37K |
| D0330 |
Panoramic radiographic image |
852 |
817 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
619 |
573 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,780 |
2,556 |
$20K |
| D0240 |
|
2,771 |
1,340 |
$19K |
| D9999 |
Unspecified adjunctive procedure, by report |
651 |
623 |
$17K |
| D1999 |
|
1,360 |
1,226 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
269 |
180 |
$13K |
| D0274 |
Bitewings - four radiographic images |
839 |
753 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
395 |
360 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
121 |
71 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,934 |
1,560 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
46 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
19 |
19 |
$178.12 |