| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
18,798 |
18,524 |
$810K |
| D0120 |
Periodic oral evaluation - established patient |
16,133 |
15,919 |
$509K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,661 |
2,388 |
$466K |
| D1206 |
Topical application of fluoride varnish |
12,835 |
12,632 |
$349K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,803 |
3,733 |
$222K |
| D0274 |
Bitewings - four radiographic images |
4,662 |
4,593 |
$191K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,778 |
1,131 |
$185K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,125 |
7,000 |
$174K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,359 |
812 |
$124K |
| D0272 |
Bitewings - two radiographic images |
3,668 |
3,622 |
$111K |
| D0140 |
Limited oral evaluation - problem focused |
2,612 |
2,539 |
$102K |
| D2160 |
|
678 |
516 |
$84K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
297 |
215 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
3,095 |
3,010 |
$50K |
| D1110 |
Prophylaxis - adult |
1,483 |
1,443 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
621 |
600 |
$40K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
268 |
196 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
546 |
437 |
$31K |
| D1351 |
Sealant - per tooth |
567 |
133 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
255 |
150 |
$21K |
| D7111 |
|
243 |
158 |
$20K |
| D2140 |
|
243 |
150 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
95 |
68 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
219 |
153 |
$3K |
| D2161 |
|
12 |
12 |
$2K |