| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,819 |
9,299 |
$350K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,811 |
2,335 |
$146K |
| D1110 |
Prophylaxis - adult |
3,168 |
2,764 |
$128K |
| D9920 |
|
1,789 |
1,513 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,341 |
1,184 |
$49K |
| D1120 |
Prophylaxis - child |
9,269 |
8,009 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
13,243 |
11,309 |
$27K |
| D0330 |
Panoramic radiographic image |
1,013 |
1,002 |
$26K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
762 |
318 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,069 |
894 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,414 |
817 |
$18K |
| D1351 |
Sealant - per tooth |
8,582 |
2,174 |
$17K |
| D1330 |
|
12,106 |
10,617 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
393 |
255 |
$17K |
| D1354 |
|
13,354 |
2,174 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,889 |
10,546 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,681 |
975 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
3,045 |
2,553 |
$12K |
| D9310 |
|
818 |
692 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,145 |
10,592 |
$10K |
| D0272 |
Bitewings - two radiographic images |
7,206 |
6,167 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
294 |
277 |
$6K |
| D8670 |
Periodic orthodontic treatment visit |
61 |
59 |
$4K |
| D0274 |
Bitewings - four radiographic images |
3,285 |
2,867 |
$2K |
| D9110 |
|
91 |
90 |
$1K |
| D9248 |
|
13 |
13 |
$1K |
| D3120 |
|
1,380 |
834 |
$1K |
| D2940 |
|
171 |
66 |
$714.14 |
| D2332 |
|
18 |
14 |
$685.80 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
54 |
15 |
$148.64 |
| D0350 |
|
166 |
136 |
$125.27 |
| D0602 |
|
116 |
116 |
$89.75 |
| D0601 |
|
35 |
35 |
$5.00 |
| D0340 |
|
15 |
15 |
$0.00 |