| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
24,199 |
23,076 |
$617K |
| D1120 |
Prophylaxis - child |
20,453 |
19,541 |
$549K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,879 |
3,995 |
$533K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,787 |
1,895 |
$525K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,353 |
2,818 |
$443K |
| D1206 |
Topical application of fluoride varnish |
26,668 |
25,498 |
$425K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,282 |
5,403 |
$274K |
| D1110 |
Prophylaxis - adult |
6,948 |
6,674 |
$261K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,855 |
864 |
$147K |
| D0330 |
Panoramic radiographic image |
2,541 |
2,480 |
$144K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,309 |
3,163 |
$143K |
| D0272 |
Bitewings - two radiographic images |
7,680 |
7,326 |
$136K |
| D7111 |
|
2,241 |
1,383 |
$112K |
| D0140 |
Limited oral evaluation - problem focused |
3,081 |
2,808 |
$111K |
| D0274 |
Bitewings - four radiographic images |
3,376 |
3,253 |
$104K |
| D1351 |
Sealant - per tooth |
2,496 |
720 |
$58K |
| D9420 |
|
303 |
255 |
$31K |
| D2330 |
|
289 |
195 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
920 |
853 |
$13K |
| D0240 |
|
347 |
205 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
173 |
110 |
$2K |
| D2331 |
|
17 |
13 |
$2K |
| D0270 |
|
62 |
54 |
$207.48 |