| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12,703 |
12,605 |
$689K |
| D1120 |
Prophylaxis - child |
14,208 |
14,096 |
$545K |
| D1351 |
Sealant - per tooth |
13,617 |
4,314 |
$387K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,311 |
14,195 |
$175K |
| D0230 |
Intraoral - periapical each additional radiographic image |
40,663 |
13,905 |
$172K |
| D0272 |
Bitewings - two radiographic images |
12,389 |
12,285 |
$145K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,774 |
910 |
$118K |
| D1310 |
|
2,073 |
2,062 |
$93K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,122 |
2,080 |
$82K |
| D9993 |
|
1,099 |
1,096 |
$68K |
| D0350 |
|
4,959 |
2,537 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
739 |
739 |
$35K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
258 |
95 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
404 |
401 |
$23K |
| D2140 |
|
358 |
216 |
$19K |
| D0603 |
|
1,078 |
1,068 |
$16K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
157 |
56 |
$16K |
| D7111 |
|
232 |
140 |
$13K |
| D0274 |
Bitewings - four radiographic images |
433 |
432 |
$9K |
| D2160 |
|
70 |
39 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
273 |
264 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
80 |
79 |
$3K |
| D0602 |
|
122 |
122 |
$2K |
| D1320 |
|
42 |
42 |
$445.00 |
| D1206 |
Topical application of fluoride varnish |
136 |
136 |
$248.00 |