| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
74,270 |
73,476 |
$2.09M |
| D1120 |
Prophylaxis - child |
58,158 |
57,414 |
$2.08M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13,111 |
8,036 |
$1.87M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
35,032 |
33,478 |
$1.31M |
| D1110 |
Prophylaxis - adult |
23,776 |
23,552 |
$1.18M |
| D2140 |
|
14,797 |
12,495 |
$1.07M |
| D0272 |
Bitewings - two radiographic images |
44,291 |
43,603 |
$944K |
| D1206 |
Topical application of fluoride varnish |
34,880 |
34,474 |
$942K |
| D1208 |
Topical application of fluoride, excluding varnish |
47,794 |
47,184 |
$936K |
| D7140 |
Extraction, erupted tooth or exposed root |
10,552 |
6,787 |
$799K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,802 |
3,507 |
$564K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,471 |
4,590 |
$547K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,304 |
9,649 |
$461K |
| D7240 |
Removal of impacted tooth - completely bony |
1,806 |
681 |
$409K |
| D1351 |
Sealant - per tooth |
11,884 |
4,472 |
$355K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,614 |
5,546 |
$279K |
| D0330 |
Panoramic radiographic image |
4,392 |
4,304 |
$259K |
| D0220 |
Intraoral - periapical first radiographic image |
15,737 |
15,010 |
$226K |
| D9243 |
|
2,248 |
963 |
$179K |
| D9248 |
|
1,149 |
1,047 |
$153K |
| D9239 |
|
950 |
890 |
$98K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,926 |
2,988 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
2,758 |
2,696 |
$42K |
| D2934 |
|
150 |
49 |
$32K |
| D2931 |
|
138 |
110 |
$29K |
| D9920 |
|
202 |
191 |
$13K |
| D9420 |
|
116 |
108 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
17 |
15 |
$7K |
| D2950 |
|
30 |
27 |
$4K |
| D2331 |
|
20 |
12 |
$2K |
| D1999 |
|
13 |
13 |
$25.00 |
| D9986 |
|
53 |
53 |
$0.00 |