| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,547 |
10,801 |
$284K |
| D1110 |
Prophylaxis - adult |
5,322 |
4,979 |
$240K |
| D0272 |
Bitewings - two radiographic images |
9,263 |
8,622 |
$195K |
| D1120 |
Prophylaxis - child |
5,865 |
5,492 |
$190K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,873 |
9,205 |
$184K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,865 |
889 |
$139K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
880 |
214 |
$119K |
| D1351 |
Sealant - per tooth |
3,720 |
1,101 |
$94K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,261 |
2,095 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
1,003 |
897 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
314 |
283 |
$26K |
| D2140 |
|
432 |
297 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,330 |
1,221 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
257 |
147 |
$17K |
| D0603 |
|
3,566 |
3,499 |
$14K |
| D0602 |
|
3,268 |
3,208 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
138 |
65 |
$11K |
| D0601 |
|
2,315 |
2,261 |
$9K |
| D2160 |
|
81 |
56 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
518 |
452 |
$7K |
| D0330 |
Panoramic radiographic image |
238 |
205 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
13 |
$2K |
| D9248 |
|
16 |
15 |
$1K |
| D1999 |
|
168 |
156 |
$0.00 |