| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
17,821 |
17,709 |
$807K |
| D0120 |
Periodic oral evaluation - established patient |
10,594 |
10,515 |
$722K |
| D0350 |
|
64,810 |
18,401 |
$608K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
7,459 |
3,732 |
$497K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,069 |
6,019 |
$408K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,120 |
1,738 |
$368K |
| D1310 |
|
7,748 |
7,742 |
$356K |
| D0230 |
Intraoral - periapical each additional radiographic image |
79,011 |
15,658 |
$329K |
| D1206 |
Topical application of fluoride varnish |
17,719 |
17,602 |
$323K |
| D1351 |
Sealant - per tooth |
8,876 |
2,506 |
$289K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,967 |
6,608 |
$275K |
| D9430 |
|
7,995 |
7,517 |
$255K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,360 |
2,263 |
$246K |
| D2140 |
|
3,698 |
2,205 |
$198K |
| D3240 |
|
1,925 |
1,317 |
$189K |
| D9993 |
|
2,286 |
2,281 |
$148K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,075 |
2,060 |
$142K |
| D0220 |
Intraoral - periapical first radiographic image |
11,516 |
11,397 |
$137K |
| D2330 |
|
1,244 |
584 |
$95K |
| D7111 |
|
1,121 |
542 |
$64K |
| D0602 |
|
4,012 |
4,008 |
$60K |
| D0601 |
|
3,674 |
3,672 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,547 |
2,535 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
575 |
569 |
$27K |
| D2160 |
|
330 |
266 |
$26K |
| D0272 |
Bitewings - two radiographic images |
2,110 |
2,102 |
$25K |
| D2331 |
|
104 |
63 |
$8K |
| D0330 |
Panoramic radiographic image |
93 |
93 |
$3K |
| D1354 |
|
119 |
53 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
46 |
46 |
$510.00 |
| D9920 |
|
28 |
24 |
$140.00 |