| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,638 |
5,626 |
$341K |
| D1120 |
Prophylaxis - child |
7,199 |
7,186 |
$284K |
| D0230 |
Intraoral - periapical each additional radiographic image |
36,300 |
7,318 |
$156K |
| D1351 |
Sealant - per tooth |
5,324 |
1,549 |
$141K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,730 |
1,730 |
$111K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,954 |
6,942 |
$90K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,287 |
600 |
$86K |
| D0274 |
Bitewings - four radiographic images |
3,959 |
3,954 |
$85K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,406 |
798 |
$80K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
884 |
525 |
$59K |
| D9993 |
|
869 |
869 |
$40K |
| D1310 |
|
870 |
870 |
$39K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
255 |
100 |
$31K |
| D2140 |
|
524 |
284 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
422 |
234 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,918 |
1,910 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,258 |
1,244 |
$15K |
| D9430 |
|
484 |
468 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
224 |
216 |
$9K |
| D1354 |
|
245 |
245 |
$8K |
| D1110 |
Prophylaxis - adult |
88 |
88 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
162 |
162 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
60 |
28 |
$6K |
| D1206 |
Topical application of fluoride varnish |
365 |
365 |
$6K |
| D0603 |
|
360 |
360 |
$5K |
| D0350 |
|
473 |
217 |
$4K |
| D1320 |
|
343 |
342 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
25 |
15 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
51 |
51 |
$3K |
| D2160 |
|
16 |
13 |
$1K |
| D0602 |
|
12 |
12 |
$180.00 |
| D1330 |
|
954 |
954 |
$0.00 |