| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,606 |
5,597 |
$325K |
| D1120 |
Prophylaxis - child |
7,049 |
7,033 |
$278K |
| D0230 |
Intraoral - periapical each additional radiographic image |
34,015 |
6,558 |
$142K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,835 |
1,832 |
$117K |
| D1206 |
Topical application of fluoride varnish |
6,643 |
6,627 |
$106K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,581 |
922 |
$104K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
880 |
336 |
$104K |
| D1351 |
Sealant - per tooth |
3,533 |
1,099 |
$102K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,810 |
1,701 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,328 |
765 |
$71K |
| D0272 |
Bitewings - two radiographic images |
5,351 |
5,333 |
$63K |
| D1310 |
|
1,480 |
1,477 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
854 |
538 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
1,047 |
1,046 |
$48K |
| D2330 |
|
543 |
303 |
$40K |
| D9430 |
|
1,161 |
1,090 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,178 |
2,091 |
$26K |
| D0145 |
Oral evaluation for a patient under three years of age |
317 |
317 |
$20K |
| D0350 |
|
2,116 |
1,246 |
$20K |
| D0603 |
|
1,298 |
1,295 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,115 |
1,111 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
122 |
50 |
$8K |
| D1110 |
Prophylaxis - adult |
86 |
86 |
$8K |
| D9993 |
|
154 |
154 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
44 |
26 |
$4K |
| D0601 |
|
121 |
121 |
$2K |
| D9110 |
|
27 |
27 |
$2K |
| D1352 |
|
45 |
12 |
$1K |