| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,659 |
8,617 |
$1.06M |
| D1351 |
Sealant - per tooth |
7,911 |
1,579 |
$265K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,209 |
1,197 |
$160K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,298 |
1,126 |
$112K |
| D0272 |
Bitewings - two radiographic images |
5,900 |
5,860 |
$99K |
| D1120 |
Prophylaxis - child |
9,265 |
9,212 |
$88K |
| D0220 |
Intraoral - periapical first radiographic image |
7,921 |
7,865 |
$66K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
829 |
200 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
426 |
365 |
$47K |
| D1206 |
Topical application of fluoride varnish |
9,861 |
9,808 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
512 |
322 |
$45K |
| D2140 |
|
1,207 |
796 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,812 |
7,663 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,191 |
709 |
$33K |
| D0274 |
Bitewings - four radiographic images |
2,478 |
2,472 |
$24K |
| D9420 |
|
27 |
25 |
$11K |
| D0330 |
Panoramic radiographic image |
852 |
844 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
98 |
77 |
$6K |
| D1110 |
Prophylaxis - adult |
310 |
309 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
51 |
51 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
106 |
41 |
$1K |
| D2160 |
|
19 |
13 |
$166.28 |