| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
16,746 |
16,725 |
$965K |
| D1120 |
Prophylaxis - child |
20,664 |
20,627 |
$818K |
| D1351 |
Sealant - per tooth |
18,749 |
5,555 |
$542K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,609 |
1,302 |
$299K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,651 |
20,612 |
$283K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,465 |
5,185 |
$212K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,022 |
1,973 |
$199K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,922 |
2,918 |
$183K |
| D0230 |
Intraoral - periapical each additional radiographic image |
43,799 |
19,847 |
$175K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,786 |
910 |
$173K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,846 |
1,826 |
$159K |
| D0272 |
Bitewings - two radiographic images |
13,062 |
13,043 |
$150K |
| D0274 |
Bitewings - four radiographic images |
5,021 |
5,017 |
$99K |
| D2160 |
|
1,235 |
903 |
$97K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,490 |
1,485 |
$91K |
| D9430 |
|
2,360 |
2,301 |
$74K |
| D0330 |
Panoramic radiographic image |
2,482 |
2,477 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
4,685 |
4,537 |
$55K |
| D0350 |
|
3,329 |
2,414 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
606 |
605 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
410 |
287 |
$27K |
| D2330 |
|
244 |
130 |
$18K |
| D1510 |
|
75 |
64 |
$10K |
| D2140 |
|
18 |
13 |
$982.80 |
| D9920 |
|
215 |
210 |
$560.00 |