| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
32,748 |
32,062 |
$833K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,169 |
2,649 |
$828K |
| D1120 |
Prophylaxis - child |
20,712 |
20,263 |
$710K |
| D1110 |
Prophylaxis - adult |
12,916 |
12,710 |
$595K |
| D1206 |
Topical application of fluoride varnish |
28,590 |
28,027 |
$549K |
| D0272 |
Bitewings - two radiographic images |
23,660 |
23,206 |
$509K |
| D9248 |
|
3,737 |
3,572 |
$337K |
| D0210 |
Intraoral - complete series of radiographic images |
3,187 |
2,987 |
$251K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,964 |
8,611 |
$224K |
| D1351 |
Sealant - per tooth |
8,290 |
2,518 |
$223K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,934 |
1,734 |
$200K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,940 |
1,324 |
$153K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,879 |
1,290 |
$134K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,328 |
797 |
$112K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,070 |
4,938 |
$95K |
| D0220 |
Intraoral - periapical first radiographic image |
5,390 |
5,218 |
$91K |
| D0140 |
Limited oral evaluation - problem focused |
2,522 |
2,445 |
$80K |
| D0603 |
|
18,480 |
18,049 |
$75K |
| D2140 |
|
627 |
463 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
617 |
462 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
865 |
855 |
$26K |
| D0602 |
|
6,362 |
6,298 |
$26K |
| D0330 |
Panoramic radiographic image |
1,549 |
1,530 |
$25K |
| D0601 |
|
1,979 |
1,960 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
798 |
472 |
$9K |
| D7111 |
|
89 |
64 |
$4K |
| D1510 |
|
17 |
12 |
$2K |
| D2330 |
|
30 |
24 |
$2K |
| D0240 |
|
15 |
14 |
$370.50 |
| D9420 |
|
91 |
79 |
$0.00 |