| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
29,504 |
27,652 |
$745K |
| D1120 |
Prophylaxis - child |
17,537 |
16,394 |
$579K |
| D1110 |
Prophylaxis - adult |
12,682 |
11,971 |
$566K |
| D1206 |
Topical application of fluoride varnish |
27,411 |
25,779 |
$520K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,770 |
1,025 |
$376K |
| D0272 |
Bitewings - two radiographic images |
14,454 |
13,629 |
$328K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,626 |
6,974 |
$188K |
| D1351 |
Sealant - per tooth |
3,817 |
973 |
$99K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,084 |
623 |
$74K |
| D2140 |
|
1,113 |
697 |
$70K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
737 |
447 |
$58K |
| D0603 |
|
13,138 |
12,368 |
$55K |
| D9248 |
|
511 |
482 |
$48K |
| D0330 |
Panoramic radiographic image |
886 |
840 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,303 |
1,161 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,223 |
1,983 |
$38K |
| D0602 |
|
8,808 |
8,278 |
$37K |
| D0601 |
|
5,026 |
4,660 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
144 |
143 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
61 |
38 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
37 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
98 |
94 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
26 |
$3K |