| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,196 |
5,176 |
$326K |
| D1120 |
Prophylaxis - child |
6,159 |
6,137 |
$252K |
| D1351 |
Sealant - per tooth |
6,640 |
2,060 |
$199K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,296 |
7,913 |
$179K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,454 |
2,449 |
$163K |
| D1110 |
Prophylaxis - adult |
1,464 |
1,459 |
$131K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,619 |
1,059 |
$108K |
| D0274 |
Bitewings - four radiographic images |
4,920 |
4,903 |
$106K |
| D2740 |
Crown - porcelain/ceramic |
210 |
166 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,523 |
7,497 |
$99K |
| D2140 |
|
1,723 |
1,028 |
$93K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,752 |
1,579 |
$70K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,181 |
639 |
$68K |
| D4910 |
|
626 |
624 |
$48K |
| D4341 |
|
598 |
158 |
$42K |
| D0350 |
|
2,554 |
1,918 |
$42K |
| D1310 |
|
897 |
892 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,313 |
2,213 |
$28K |
| D9993 |
|
338 |
338 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,705 |
1,705 |
$20K |
| D9430 |
|
408 |
393 |
$13K |
| D2954 |
|
104 |
76 |
$11K |
| D4342 |
|
130 |
34 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
99 |
61 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
46 |
25 |
$5K |
| D0603 |
|
248 |
244 |
$4K |
| D2160 |
|
18 |
14 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
12 |
$922.80 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$576.00 |
| D0270 |
|
13 |
13 |
$65.00 |