| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,923 |
8,891 |
$564K |
| D1120 |
Prophylaxis - child |
13,658 |
13,617 |
$546K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,977 |
4,438 |
$512K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,735 |
7,341 |
$294K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,213 |
4,207 |
$272K |
| D1351 |
Sealant - per tooth |
6,983 |
2,367 |
$211K |
| D1310 |
|
4,688 |
4,672 |
$208K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,132 |
1,938 |
$174K |
| D9993 |
|
2,167 |
2,165 |
$138K |
| D1206 |
Topical application of fluoride varnish |
8,944 |
8,912 |
$133K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,830 |
12,971 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,223 |
1,598 |
$116K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
759 |
582 |
$87K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,066 |
844 |
$81K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,329 |
1,328 |
$80K |
| D0272 |
Bitewings - two radiographic images |
6,815 |
6,789 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,208 |
4,200 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
5,313 |
5,240 |
$62K |
| D0274 |
Bitewings - four radiographic images |
2,610 |
2,605 |
$49K |
| D0603 |
|
2,229 |
2,218 |
$32K |
| D2330 |
|
404 |
275 |
$30K |
| D0602 |
|
1,812 |
1,805 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
547 |
547 |
$25K |
| D9430 |
|
586 |
552 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
164 |
139 |
$16K |
| D0330 |
Panoramic radiographic image |
668 |
667 |
$15K |
| D1510 |
|
13 |
12 |
$2K |
| D1999 |
|
17 |
17 |
$51.00 |
| D1110 |
Prophylaxis - adult |
15 |
15 |
$0.00 |