| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,652 |
7,639 |
$422K |
| D1120 |
Prophylaxis - child |
7,435 |
7,421 |
$284K |
| D0230 |
Intraoral - periapical each additional radiographic image |
53,632 |
9,406 |
$214K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,009 |
1,447 |
$202K |
| D1110 |
Prophylaxis - adult |
1,457 |
1,450 |
$126K |
| D0272 |
Bitewings - two radiographic images |
8,025 |
8,011 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,377 |
1,374 |
$88K |
| D1351 |
Sealant - per tooth |
3,128 |
657 |
$80K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,381 |
807 |
$79K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,888 |
1,648 |
$74K |
| D2140 |
|
1,095 |
645 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,386 |
3,374 |
$46K |
| D1206 |
Topical application of fluoride varnish |
3,893 |
3,891 |
$36K |
| D4341 |
|
429 |
114 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,196 |
2,129 |
$26K |
| D2160 |
|
296 |
207 |
$23K |
| D0350 |
|
1,752 |
974 |
$17K |
| D4910 |
|
213 |
213 |
$16K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
16 |
14 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
39 |
24 |
$4K |