| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
14,412 |
14,412 |
$411K |
| D1120 |
Prophylaxis - child |
12,722 |
12,721 |
$374K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,617 |
3,356 |
$209K |
| D0220 |
Intraoral - periapical first radiographic image |
15,110 |
14,978 |
$180K |
| D1206 |
Topical application of fluoride varnish |
9,989 |
9,989 |
$172K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
257 |
234 |
$157K |
| D0274 |
Bitewings - four radiographic images |
4,792 |
4,792 |
$153K |
| D0272 |
Bitewings - two radiographic images |
7,444 |
7,444 |
$143K |
| D1110 |
Prophylaxis - adult |
2,705 |
2,705 |
$113K |
| D0240 |
|
4,603 |
4,600 |
$103K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,096 |
496 |
$92K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,151 |
8,136 |
$73K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,150 |
698 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,934 |
5,934 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
826 |
593 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,328 |
1,307 |
$38K |
| D1351 |
Sealant - per tooth |
987 |
340 |
$29K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
308 |
200 |
$21K |
| D0330 |
Panoramic radiographic image |
367 |
367 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
179 |
106 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
242 |
242 |
$8K |
| D2140 |
|
165 |
109 |
$7K |
| D1354 |
|
126 |
26 |
$1K |
| D9310 |
|
14 |
14 |
$865.28 |