| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,231 |
10,213 |
$579K |
| D1120 |
Prophylaxis - child |
11,865 |
11,826 |
$460K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,642 |
3,105 |
$304K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,043 |
3,197 |
$267K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,820 |
5,039 |
$227K |
| D0230 |
Intraoral - periapical each additional radiographic image |
48,798 |
13,990 |
$203K |
| D0350 |
|
14,551 |
7,991 |
$150K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,257 |
1,485 |
$149K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,582 |
11,544 |
$144K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,129 |
1,526 |
$120K |
| D0272 |
Bitewings - two radiographic images |
10,016 |
9,989 |
$118K |
| D0220 |
Intraoral - periapical first radiographic image |
9,650 |
8,664 |
$114K |
| D1351 |
Sealant - per tooth |
2,283 |
1,017 |
$65K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
748 |
631 |
$58K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
486 |
357 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
816 |
811 |
$45K |
| D2160 |
|
289 |
237 |
$23K |
| D2330 |
|
79 |
53 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
65 |
64 |
$3K |
| D2140 |
|
49 |
37 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
21 |
12 |
$2K |
| D9430 |
|
17 |
17 |
$544.00 |
| D0270 |
|
13 |
13 |
$65.00 |