| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,521 |
4,493 |
$223K |
| D1120 |
Prophylaxis - child |
5,727 |
5,685 |
$200K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
906 |
520 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,485 |
5,851 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,411 |
4,389 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,966 |
1,953 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
994 |
896 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,221 |
2,208 |
$25K |
| D1351 |
Sealant - per tooth |
1,209 |
414 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
314 |
178 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
239 |
146 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
263 |
258 |
$12K |
| D9993 |
|
185 |
185 |
$11K |
| D1310 |
|
221 |
221 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
137 |
78 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
40 |
25 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
48 |
24 |
$5K |
| D0603 |
|
124 |
124 |
$2K |
| D2140 |
|
30 |
26 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$336.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$195.00 |
| D1203 |
|
14 |
14 |
$0.00 |