| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
17,958 |
17,454 |
$423K |
| D1120 |
Prophylaxis - child |
15,103 |
14,683 |
$330K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,727 |
2,593 |
$314K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,621 |
18,067 |
$304K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,270 |
1,745 |
$170K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,943 |
1,630 |
$164K |
| D1110 |
Prophylaxis - adult |
4,102 |
3,956 |
$147K |
| D9999 |
Unspecified adjunctive procedure, by report |
3,699 |
3,603 |
$100K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
839 |
349 |
$96K |
| D1351 |
Sealant - per tooth |
4,068 |
1,191 |
$86K |
| D0272 |
Bitewings - two radiographic images |
7,602 |
7,384 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
8,766 |
8,454 |
$68K |
| D9920 |
|
2,294 |
2,170 |
$64K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,398 |
2,043 |
$48K |
| D0330 |
Panoramic radiographic image |
961 |
925 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
947 |
892 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,471 |
1,397 |
$29K |
| D1999 |
|
2,344 |
1,867 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,507 |
7,885 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
153 |
123 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
21 |
15 |
$2K |
| D1206 |
Topical application of fluoride varnish |
100 |
98 |
$2K |
| D0274 |
Bitewings - four radiographic images |
88 |
85 |
$1K |
| D9992 |
|
19 |
17 |
$270.00 |