| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,041 |
12,971 |
$754K |
| D1120 |
Prophylaxis - child |
17,966 |
17,865 |
$718K |
| D0230 |
Intraoral - periapical each additional radiographic image |
83,816 |
16,915 |
$348K |
| D1351 |
Sealant - per tooth |
10,155 |
4,198 |
$302K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,379 |
18,271 |
$278K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,022 |
4,007 |
$258K |
| D1310 |
|
5,294 |
5,254 |
$241K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,541 |
1,806 |
$192K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,592 |
1,542 |
$173K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,682 |
1,696 |
$153K |
| D0274 |
Bitewings - four radiographic images |
7,183 |
7,143 |
$153K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,146 |
1,198 |
$143K |
| D9993 |
|
2,056 |
2,056 |
$132K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
960 |
550 |
$113K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,698 |
1,689 |
$103K |
| D0350 |
|
9,490 |
4,849 |
$100K |
| D0220 |
Intraoral - periapical first radiographic image |
8,071 |
7,911 |
$95K |
| D2140 |
|
1,592 |
933 |
$86K |
| D0340 |
|
1,432 |
1,416 |
$71K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,316 |
1,286 |
$52K |
| D2330 |
|
667 |
406 |
$50K |
| D0330 |
Panoramic radiographic image |
1,494 |
1,482 |
$43K |
| D0602 |
|
2,660 |
2,643 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,150 |
1,138 |
$39K |
| D0603 |
|
2,593 |
2,572 |
$38K |
| D0272 |
Bitewings - two radiographic images |
3,114 |
3,099 |
$37K |
| D9430 |
|
1,044 |
988 |
$33K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
138 |
81 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$1K |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$480.00 |