| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
25,325 |
25,026 |
$716K |
| D1120 |
Prophylaxis - child |
17,834 |
17,526 |
$629K |
| D1110 |
Prophylaxis - adult |
8,682 |
8,615 |
$433K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,121 |
10,548 |
$417K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,303 |
17,024 |
$334K |
| D0272 |
Bitewings - two radiographic images |
14,443 |
14,240 |
$307K |
| D1206 |
Topical application of fluoride varnish |
8,780 |
8,626 |
$242K |
| D2140 |
|
2,843 |
2,487 |
$208K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
869 |
622 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,352 |
1,310 |
$61K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
555 |
465 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
2,489 |
2,394 |
$37K |
| D0330 |
Panoramic radiographic image |
420 |
401 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
375 |
258 |
$29K |
| D0145 |
Oral evaluation for a patient under three years of age |
589 |
581 |
$28K |
| D1351 |
Sealant - per tooth |
717 |
230 |
$24K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
111 |
63 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
65 |
64 |
$1K |
| D9986 |
|
555 |
538 |
$0.00 |