| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12,711 |
12,597 |
$1.43M |
| D1351 |
Sealant - per tooth |
13,270 |
2,239 |
$397K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,953 |
1,921 |
$231K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,035 |
1,789 |
$192K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,661 |
801 |
$140K |
| D0272 |
Bitewings - two radiographic images |
9,663 |
9,565 |
$121K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,138 |
1,126 |
$100K |
| D2140 |
|
2,056 |
1,270 |
$95K |
| D0220 |
Intraoral - periapical first radiographic image |
4,911 |
4,807 |
$70K |
| D0140 |
Limited oral evaluation - problem focused |
1,402 |
1,362 |
$64K |
| D0330 |
Panoramic radiographic image |
2,152 |
2,132 |
$60K |
| D9248 |
|
497 |
493 |
$40K |
| D1120 |
Prophylaxis - child |
13,730 |
13,590 |
$39K |
| D1206 |
Topical application of fluoride varnish |
12,389 |
12,277 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,622 |
2,982 |
$10K |
| D2332 |
|
439 |
237 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
523 |
264 |
$7K |
| D0274 |
Bitewings - four radiographic images |
3,018 |
2,986 |
$5K |
| D1999 |
|
172 |
160 |
$5K |
| D2160 |
|
108 |
63 |
$2K |
| D1110 |
Prophylaxis - adult |
818 |
806 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
217 |
201 |
$974.64 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,313 |
1,288 |
$264.00 |
| D0240 |
|
27 |
26 |
$0.00 |