| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,008 |
5,975 |
$366K |
| D1120 |
Prophylaxis - child |
8,096 |
8,057 |
$331K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,236 |
567 |
$147K |
| D1351 |
Sealant - per tooth |
4,537 |
1,156 |
$133K |
| D1310 |
|
2,924 |
2,906 |
$132K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,148 |
7,383 |
$128K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,000 |
7,961 |
$121K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,746 |
1,740 |
$113K |
| D9993 |
|
1,393 |
1,390 |
$81K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,051 |
1,916 |
$80K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,225 |
552 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
6,222 |
6,157 |
$74K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
779 |
359 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
853 |
425 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,374 |
1,369 |
$29K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
286 |
140 |
$28K |
| D0603 |
|
1,888 |
1,874 |
$28K |
| D0350 |
|
2,187 |
1,063 |
$21K |
| D0330 |
Panoramic radiographic image |
600 |
598 |
$18K |
| D9430 |
|
511 |
503 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
261 |
259 |
$16K |
| D0601 |
|
880 |
880 |
$13K |
| D2332 |
|
21 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$168.00 |
| D1999 |
|
113 |
102 |
$0.00 |