| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,868 |
9,757 |
$199K |
| D0120 |
Periodic oral evaluation - established patient |
9,898 |
9,809 |
$172K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,590 |
1,289 |
$156K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,135 |
1,188 |
$110K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
933 |
299 |
$104K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,882 |
6,811 |
$101K |
| D1351 |
Sealant - per tooth |
4,321 |
1,139 |
$91K |
| D2140 |
|
2,092 |
1,117 |
$85K |
| D1206 |
Topical application of fluoride varnish |
4,734 |
4,717 |
$76K |
| D0272 |
Bitewings - two radiographic images |
6,790 |
6,694 |
$65K |
| D1110 |
Prophylaxis - adult |
1,822 |
1,779 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,236 |
2,217 |
$57K |
| D0274 |
Bitewings - four radiographic images |
2,339 |
2,321 |
$46K |
| D0330 |
Panoramic radiographic image |
878 |
874 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,526 |
1,468 |
$34K |
| D0240 |
|
2,126 |
1,217 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,635 |
1,456 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
3,145 |
2,825 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
317 |
266 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
57 |
36 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
61 |
42 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
65 |
32 |
$4K |
| D2332 |
|
28 |
13 |
$2K |
| D1320 |
|
13 |
12 |
$60.00 |
| D1330 |
|
79 |
79 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
71 |
70 |
$0.00 |
| D7999 |
|
38 |
38 |
$0.00 |