| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
18,615 |
18,426 |
$659K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,450 |
1,047 |
$581K |
| D0120 |
Periodic oral evaluation - established patient |
18,134 |
17,951 |
$523K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,210 |
3,359 |
$465K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,379 |
20,184 |
$416K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,183 |
3,616 |
$400K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,139 |
8,302 |
$328K |
| D0272 |
Bitewings - two radiographic images |
13,015 |
12,809 |
$285K |
| D1110 |
Prophylaxis - adult |
4,516 |
4,477 |
$222K |
| D2140 |
|
2,764 |
2,033 |
$201K |
| D1351 |
Sealant - per tooth |
6,004 |
1,549 |
$199K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,498 |
3,433 |
$169K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,209 |
2,186 |
$106K |
| D0220 |
Intraoral - periapical first radiographic image |
3,731 |
3,517 |
$57K |
| D9420 |
|
330 |
300 |
$29K |
| D2933 |
|
80 |
25 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
647 |
640 |
$9K |
| D2330 |
|
108 |
77 |
$9K |
| D0330 |
Panoramic radiographic image |
125 |
124 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
365 |
264 |
$4K |
| D2331 |
|
33 |
27 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38 |
26 |
$3K |
| D1206 |
Topical application of fluoride varnish |
622 |
520 |
$218.61 |
| D9986 |
|
12 |
12 |
$0.00 |
| D9110 |
|
15 |
15 |
$0.00 |