| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,922 |
9,922 |
$355K |
| D1120 |
Prophylaxis - child |
8,970 |
8,970 |
$342K |
| D1206 |
Topical application of fluoride varnish |
7,688 |
7,688 |
$150K |
| D0272 |
Bitewings - two radiographic images |
4,928 |
4,928 |
$128K |
| D0274 |
Bitewings - four radiographic images |
2,399 |
2,399 |
$123K |
| D0220 |
Intraoral - periapical first radiographic image |
4,565 |
4,545 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,801 |
3,688 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
683 |
664 |
$39K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
284 |
126 |
$30K |
| D1110 |
Prophylaxis - adult |
530 |
530 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
319 |
210 |
$21K |
| D0330 |
Panoramic radiographic image |
222 |
222 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,460 |
2,460 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
178 |
173 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
42 |
28 |
$6K |
| D2140 |
|
93 |
79 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
47 |
27 |
$4K |
| D1354 |
|
338 |
128 |
$2K |