| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
67,608 |
67,018 |
$1.93M |
| D1120 |
Prophylaxis - child |
49,377 |
49,048 |
$1.79M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,913 |
5,647 |
$1.25M |
| D1110 |
Prophylaxis - adult |
24,101 |
23,872 |
$1.21M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
28,990 |
28,057 |
$1.09M |
| D0272 |
Bitewings - two radiographic images |
42,163 |
41,726 |
$903K |
| D2140 |
|
12,224 |
10,869 |
$881K |
| D1208 |
Topical application of fluoride, excluding varnish |
42,485 |
42,124 |
$847K |
| D1206 |
Topical application of fluoride varnish |
31,371 |
31,132 |
$847K |
| D7240 |
Removal of impacted tooth - completely bony |
2,435 |
888 |
$576K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,612 |
3,695 |
$417K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,581 |
3,147 |
$359K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,108 |
6,500 |
$312K |
| D1351 |
Sealant - per tooth |
9,474 |
3,395 |
$285K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,306 |
5,227 |
$258K |
| D0330 |
Panoramic radiographic image |
3,897 |
3,849 |
$246K |
| D9243 |
|
2,877 |
1,129 |
$234K |
| D0220 |
Intraoral - periapical first radiographic image |
11,601 |
11,275 |
$171K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,670 |
1,128 |
$166K |
| D9239 |
|
1,065 |
1,020 |
$114K |
| D0140 |
Limited oral evaluation - problem focused |
1,320 |
1,296 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
713 |
590 |
$7K |
| D9920 |
|
132 |
100 |
$6K |
| D9420 |
|
51 |
51 |
$5K |
| D9248 |
|
26 |
25 |
$4K |
| D1999 |
|
63 |
62 |
$305.00 |
| D9986 |
|
488 |
474 |
$0.00 |