| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,237 |
6,020 |
$197K |
| D0120 |
Periodic oral evaluation - established patient |
7,931 |
7,675 |
$195K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,110 |
7,846 |
$146K |
| D0272 |
Bitewings - two radiographic images |
6,533 |
6,315 |
$138K |
| D1110 |
Prophylaxis - adult |
2,026 |
1,977 |
$92K |
| D0240 |
|
3,220 |
1,810 |
$73K |
| D0210 |
Intraoral - complete series of radiographic images |
737 |
712 |
$55K |
| D1351 |
Sealant - per tooth |
1,986 |
558 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,623 |
1,491 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
1,970 |
1,830 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
469 |
251 |
$29K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
221 |
55 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
240 |
119 |
$18K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
183 |
53 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
441 |
427 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
199 |
103 |
$13K |
| D0274 |
Bitewings - four radiographic images |
460 |
453 |
$9K |
| D9248 |
|
79 |
72 |
$7K |
| D0330 |
Panoramic radiographic image |
113 |
112 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
166 |
128 |
$2K |
| D0601 |
|
132 |
125 |
$586.04 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
15 |
$448.80 |
| D1999 |
|
78 |
72 |
$0.00 |