| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,929 |
10,804 |
$265K |
| D1120 |
Prophylaxis - child |
7,422 |
7,345 |
$248K |
| D1110 |
Prophylaxis - adult |
5,403 |
5,342 |
$230K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,136 |
11,024 |
$229K |
| D0210 |
Intraoral - complete series of radiographic images |
2,379 |
2,356 |
$142K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,933 |
2,740 |
$85K |
| D0274 |
Bitewings - four radiographic images |
2,565 |
2,540 |
$69K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
839 |
335 |
$62K |
| D0272 |
Bitewings - two radiographic images |
3,220 |
3,186 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
3,567 |
3,504 |
$44K |
| D1351 |
Sealant - per tooth |
1,514 |
434 |
$43K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
490 |
245 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,162 |
1,154 |
$33K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
297 |
141 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,941 |
2,867 |
$28K |
| D1206 |
Topical application of fluoride varnish |
609 |
608 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
158 |
73 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
178 |
122 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
110 |
67 |
$6K |
| D2140 |
|
90 |
43 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
49 |
49 |
$1K |