| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,749 |
9,685 |
$229K |
| D1110 |
Prophylaxis - adult |
4,953 |
4,933 |
$220K |
| D1120 |
Prophylaxis - child |
5,849 |
5,806 |
$193K |
| D1206 |
Topical application of fluoride varnish |
9,512 |
9,446 |
$182K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,329 |
770 |
$137K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
747 |
494 |
$90K |
| D0274 |
Bitewings - four radiographic images |
2,768 |
2,753 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,009 |
2,000 |
$77K |
| D0330 |
Panoramic radiographic image |
1,481 |
1,479 |
$76K |
| D1351 |
Sealant - per tooth |
2,137 |
646 |
$74K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,931 |
1,814 |
$60K |
| D0272 |
Bitewings - two radiographic images |
2,861 |
2,841 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
341 |
235 |
$34K |
| D2140 |
|
251 |
176 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
129 |
78 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
806 |
792 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
805 |
799 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
254 |
252 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
77 |
57 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
31 |
24 |
$3K |
| D2331 |
|
17 |
12 |
$2K |
| D1353 |
|
40 |
13 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
24 |
24 |
$941.65 |
| D3120 |
|
16 |
13 |
$577.28 |