| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,492 |
7,474 |
$413K |
| D1120 |
Prophylaxis - child |
7,924 |
7,904 |
$305K |
| D1206 |
Topical application of fluoride varnish |
8,013 |
7,986 |
$103K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,388 |
651 |
$93K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,666 |
8,640 |
$82K |
| D0272 |
Bitewings - two radiographic images |
6,775 |
6,754 |
$80K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,441 |
1,373 |
$57K |
| D9993 |
|
854 |
853 |
$53K |
| D1310 |
|
1,129 |
1,126 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
557 |
386 |
$32K |
| D1351 |
Sealant - per tooth |
1,100 |
373 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,421 |
1,390 |
$17K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
124 |
72 |
$14K |
| D0274 |
Bitewings - four radiographic images |
638 |
638 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
103 |
56 |
$10K |
| D9430 |
|
240 |
234 |
$7K |
| D0603 |
|
274 |
274 |
$4K |
| D0602 |
|
230 |
230 |
$3K |
| D0350 |
|
346 |
247 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
41 |
41 |
$2K |
| D2140 |
|
17 |
12 |
$928.20 |
| D0601 |
|
26 |
26 |
$390.00 |
| D1999 |
|
13 |
13 |
$25.00 |