| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,250 |
5,217 |
$348K |
| D1120 |
Prophylaxis - child |
7,641 |
7,604 |
$348K |
| D1310 |
|
4,242 |
4,221 |
$193K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,341 |
7,907 |
$151K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,629 |
7,594 |
$142K |
| D1351 |
Sealant - per tooth |
3,851 |
926 |
$131K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,759 |
1,754 |
$120K |
| D9993 |
|
1,292 |
1,292 |
$84K |
| D0145 |
Oral evaluation for a patient under three years of age |
652 |
652 |
$47K |
| D0603 |
|
2,832 |
2,816 |
$42K |
| D0272 |
Bitewings - two radiographic images |
3,727 |
3,706 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,525 |
2,513 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,285 |
1,273 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
665 |
661 |
$26K |
| D0601 |
|
1,269 |
1,263 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
300 |
202 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
234 |
102 |
$16K |
| D9430 |
|
221 |
216 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
52 |
24 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
56 |
24 |
$6K |
| D0350 |
|
282 |
157 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
24 |
24 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$156.00 |
| D1330 |
|
34 |
34 |
$0.00 |