| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12,492 |
12,433 |
$719K |
| D1120 |
Prophylaxis - child |
17,393 |
17,315 |
$682K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,552 |
3,081 |
$363K |
| D0230 |
Intraoral - periapical each additional radiographic image |
75,819 |
16,399 |
$325K |
| D1310 |
|
7,138 |
7,109 |
$323K |
| D1351 |
Sealant - per tooth |
10,910 |
3,979 |
$316K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,051 |
4,041 |
$251K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,044 |
1,392 |
$233K |
| D7111 |
|
3,835 |
2,351 |
$217K |
| D9993 |
|
3,199 |
3,193 |
$205K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,331 |
4,154 |
$169K |
| D1206 |
Topical application of fluoride varnish |
7,557 |
7,521 |
$164K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,716 |
1,230 |
$164K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,149 |
2,143 |
$128K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,788 |
9,746 |
$108K |
| D2140 |
|
1,624 |
1,076 |
$86K |
| D0272 |
Bitewings - two radiographic images |
6,859 |
6,823 |
$78K |
| D9248 |
|
2,099 |
2,049 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,336 |
989 |
$68K |
| D0603 |
|
4,609 |
4,592 |
$67K |
| D0274 |
Bitewings - four radiographic images |
3,118 |
3,104 |
$65K |
| D9430 |
|
1,727 |
1,674 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
1,239 |
1,234 |
$54K |
| D2330 |
|
700 |
450 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
3,884 |
3,866 |
$43K |
| D0350 |
|
4,580 |
2,900 |
$42K |
| D0602 |
|
2,198 |
2,190 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
564 |
390 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
522 |
349 |
$29K |
| D2160 |
|
108 |
88 |
$9K |
| D9920 |
|
78 |
77 |
$7K |
| D1510 |
|
43 |
38 |
$6K |
| D1354 |
|
110 |
25 |
$1K |
| D0601 |
|
78 |
78 |
$1K |
| D9910 |
|
26 |
26 |
$421.40 |
| D1999 |
|
52 |
50 |
$60.00 |