| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
74,595 |
73,705 |
$2.13M |
| D1120 |
Prophylaxis - child |
51,030 |
50,445 |
$1.86M |
| D1110 |
Prophylaxis - adult |
29,419 |
29,030 |
$1.48M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
32,160 |
30,559 |
$1.20M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,024 |
5,794 |
$1.13M |
| D2140 |
|
14,404 |
12,638 |
$1.02M |
| D0272 |
Bitewings - two radiographic images |
45,190 |
44,518 |
$978K |
| D1208 |
Topical application of fluoride, excluding varnish |
47,731 |
47,233 |
$948K |
| D1206 |
Topical application of fluoride varnish |
32,081 |
31,600 |
$879K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,925 |
4,222 |
$490K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,026 |
3,957 |
$450K |
| D1351 |
Sealant - per tooth |
10,596 |
3,640 |
$325K |
| D0145 |
Oral evaluation for a patient under three years of age |
6,341 |
6,252 |
$312K |
| D0330 |
Panoramic radiographic image |
4,450 |
4,348 |
$286K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,658 |
5,506 |
$262K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,244 |
1,640 |
$219K |
| D0220 |
Intraoral - periapical first radiographic image |
13,593 |
13,144 |
$200K |
| D0140 |
Limited oral evaluation - problem focused |
2,577 |
2,507 |
$37K |
| D9920 |
|
400 |
351 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,762 |
1,411 |
$20K |
| D9248 |
|
37 |
36 |
$6K |
| D9420 |
|
42 |
42 |
$4K |
| D9986 |
|
3,487 |
3,252 |
$0.00 |
| D0350 |
|
36 |
25 |
$0.00 |
| D1999 |
|
14 |
12 |
$0.00 |
| D0270 |
|
18 |
17 |
$0.00 |