| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
24,045 |
23,269 |
$982K |
| D0120 |
Periodic oral evaluation - established patient |
22,157 |
21,466 |
$618K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,708 |
22,931 |
$614K |
| D1351 |
Sealant - per tooth |
7,357 |
3,974 |
$415K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,476 |
2,416 |
$319K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,467 |
4,606 |
$210K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,614 |
2,626 |
$178K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,126 |
19,663 |
$167K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,468 |
1,969 |
$143K |
| D0220 |
Intraoral - periapical first radiographic image |
22,874 |
21,806 |
$137K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,467 |
5,183 |
$119K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,666 |
1,135 |
$98K |
| D1354 |
|
2,946 |
2,147 |
$92K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,322 |
856 |
$70K |
| D0274 |
Bitewings - four radiographic images |
3,914 |
3,732 |
$68K |
| D0272 |
Bitewings - two radiographic images |
3,982 |
3,756 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
958 |
815 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,898 |
1,818 |
$32K |
| D1510 |
|
333 |
290 |
$24K |
| D1110 |
Prophylaxis - adult |
668 |
648 |
$22K |
| D2140 |
|
557 |
396 |
$18K |
| D9110 |
|
248 |
238 |
$13K |
| D0330 |
Panoramic radiographic image |
354 |
302 |
$9K |
| D2160 |
|
106 |
90 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
46 |
32 |
$3K |
| D1206 |
Topical application of fluoride varnish |
45 |
44 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
12 |
$803.60 |
| D0210 |
Intraoral - complete series of radiographic images |
47 |
46 |
$303.80 |