| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,700 |
9,675 |
$402K |
| D0120 |
Periodic oral evaluation - established patient |
5,577 |
5,566 |
$343K |
| D1310 |
|
4,228 |
4,219 |
$193K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,674 |
2,666 |
$176K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,221 |
10,198 |
$171K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,108 |
8,792 |
$170K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,287 |
1,027 |
$153K |
| D9993 |
|
1,913 |
1,913 |
$115K |
| D1351 |
Sealant - per tooth |
3,378 |
1,030 |
$99K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,039 |
2,015 |
$81K |
| D2140 |
|
1,331 |
643 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
4,818 |
4,772 |
$57K |
| D7140 |
Extraction, erupted tooth or exposed root |
895 |
452 |
$51K |
| D0603 |
|
2,871 |
2,866 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,840 |
1,838 |
$40K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
310 |
136 |
$37K |
| D0145 |
Oral evaluation for a patient under three years of age |
461 |
461 |
$31K |
| D0350 |
|
1,515 |
1,422 |
$30K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
167 |
63 |
$17K |
| D0602 |
|
809 |
808 |
$12K |
| D0272 |
Bitewings - two radiographic images |
997 |
992 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
195 |
195 |
$9K |
| D1110 |
Prophylaxis - adult |
95 |
95 |
$8K |
| D1320 |
|
327 |
327 |
$4K |
| D7111 |
|
50 |
27 |
$3K |
| D2160 |
|
27 |
13 |
$2K |
| D9430 |
|
51 |
51 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
46 |
46 |
$2K |
| D0330 |
Panoramic radiographic image |
31 |
31 |
$785.00 |