| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
22,126 |
20,887 |
$570K |
| D1110 |
Prophylaxis - adult |
12,054 |
11,465 |
$551K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,213 |
16,271 |
$330K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,847 |
2,143 |
$327K |
| D1120 |
Prophylaxis - child |
9,463 |
8,872 |
$325K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,530 |
1,987 |
$273K |
| D0272 |
Bitewings - two radiographic images |
9,760 |
9,216 |
$225K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,445 |
1,829 |
$205K |
| D0210 |
Intraoral - complete series of radiographic images |
2,429 |
2,305 |
$196K |
| D2140 |
|
2,068 |
1,381 |
$130K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,684 |
1,000 |
$84K |
| D0140 |
Limited oral evaluation - problem focused |
1,854 |
1,690 |
$60K |
| D0330 |
Panoramic radiographic image |
1,354 |
1,304 |
$60K |
| D2160 |
|
624 |
410 |
$56K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,998 |
1,648 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
2,834 |
2,556 |
$48K |
| D2331 |
|
510 |
344 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
293 |
174 |
$22K |
| D0603 |
|
3,123 |
2,774 |
$15K |
| D1206 |
Topical application of fluoride varnish |
522 |
503 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
66 |
50 |
$8K |
| D0602 |
|
1,034 |
822 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
33 |
26 |
$3K |
| D9920 |
|
99 |
97 |
$2K |
| D2330 |
|
18 |
12 |
$1K |
| D0601 |
|
131 |
88 |
$650.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
12 |
$171.00 |
| D1999 |
|
31 |
30 |
$15.00 |