| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
16,774 |
15,366 |
$418K |
| D1110 |
Prophylaxis - adult |
8,280 |
7,555 |
$382K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,520 |
16,082 |
$331K |
| D0272 |
Bitewings - two radiographic images |
14,761 |
13,490 |
$327K |
| D1120 |
Prophylaxis - child |
9,316 |
8,574 |
$306K |
| D0220 |
Intraoral - periapical first radiographic image |
17,139 |
15,547 |
$284K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,325 |
14,816 |
$217K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,315 |
617 |
$180K |
| D9248 |
|
1,686 |
1,599 |
$152K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,491 |
920 |
$109K |
| D2140 |
|
1,733 |
1,191 |
$105K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,218 |
3,981 |
$99K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
612 |
409 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
746 |
485 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
1,438 |
1,348 |
$44K |
| D1351 |
Sealant - per tooth |
462 |
125 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
124 |
123 |
$4K |
| D1206 |
Topical application of fluoride varnish |
97 |
88 |
$2K |
| D1999 |
|
12 |
12 |
$0.00 |