| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,598 |
6,562 |
$218K |
| D1110 |
Prophylaxis - adult |
4,232 |
4,203 |
$207K |
| D1206 |
Topical application of fluoride varnish |
7,869 |
7,826 |
$199K |
| D1120 |
Prophylaxis - child |
4,223 |
4,209 |
$138K |
| D0274 |
Bitewings - four radiographic images |
3,519 |
3,493 |
$123K |
| D0330 |
Panoramic radiographic image |
1,913 |
1,906 |
$117K |
| D0140 |
Limited oral evaluation - problem focused |
2,480 |
2,400 |
$87K |
| D0272 |
Bitewings - two radiographic images |
2,662 |
2,649 |
$78K |
| D1351 |
Sealant - per tooth |
2,519 |
668 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,206 |
579 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,946 |
1,940 |
$58K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
752 |
173 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
422 |
249 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
1,951 |
1,909 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
416 |
262 |
$25K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
82 |
39 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
129 |
87 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
184 |
183 |
$7K |
| D2140 |
|
97 |
65 |
$7K |
| D0160 |
|
179 |
179 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
398 |
366 |
$5K |
| D1354 |
|
259 |
116 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
105 |
88 |
$943.99 |
| D9420 |
|
46 |
46 |
$751.17 |
| D1999 |
|
530 |
470 |
$0.00 |
| D9995 |
|
18 |
17 |
$0.00 |
| D4355 |
|
12 |
12 |
$0.00 |