| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,514 |
8,368 |
$341K |
| D1110 |
Prophylaxis - adult |
4,012 |
3,951 |
$288K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,566 |
1,680 |
$142K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
996 |
978 |
$50K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
442 |
310 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,709 |
2,498 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
989 |
770 |
$39K |
| D1120 |
Prophylaxis - child |
5,565 |
5,466 |
$28K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
189 |
150 |
$22K |
| D1351 |
Sealant - per tooth |
8,116 |
2,427 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,153 |
6,663 |
$12K |
| D0330 |
Panoramic radiographic image |
791 |
767 |
$12K |
| D1330 |
|
9,534 |
9,377 |
$12K |
| D1206 |
Topical application of fluoride varnish |
9,445 |
9,289 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
7,492 |
7,229 |
$8K |
| D0274 |
Bitewings - four radiographic images |
4,288 |
4,218 |
$8K |
| D0272 |
Bitewings - two radiographic images |
3,801 |
3,737 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
185 |
151 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
58 |
40 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
123 |
118 |
$2K |
| D3120 |
|
430 |
327 |
$793.97 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$571.55 |
| D7111 |
|
35 |
28 |
$498.97 |