| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,360 |
5,359 |
$241K |
| D1120 |
Prophylaxis - child |
5,176 |
5,176 |
$233K |
| D1351 |
Sealant - per tooth |
4,660 |
1,744 |
$210K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,882 |
911 |
$206K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,296 |
586 |
$141K |
| D0272 |
Bitewings - two radiographic images |
4,063 |
4,062 |
$138K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,081 |
569 |
$135K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,653 |
3,653 |
$82K |
| D0220 |
Intraoral - periapical first radiographic image |
4,754 |
4,676 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,438 |
4,411 |
$71K |
| D9920 |
|
1,578 |
1,418 |
$58K |
| D1206 |
Topical application of fluoride varnish |
1,716 |
1,716 |
$55K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
441 |
268 |
$52K |
| D0330 |
Panoramic radiographic image |
594 |
594 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,217 |
2,070 |
$44K |
| D2160 |
|
308 |
210 |
$37K |
| D0603 |
|
2,519 |
2,519 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
250 |
149 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
291 |
291 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
462 |
445 |
$21K |
| D7111 |
|
247 |
157 |
$14K |
| D2330 |
|
68 |
32 |
$5K |
| D2932 |
|
24 |
12 |
$5K |
| D1110 |
Prophylaxis - adult |
54 |
54 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
23 |
12 |
$3K |
| D2331 |
|
28 |
13 |
$3K |
| D2332 |
|
18 |
12 |
$2K |
| D9430 |
|
12 |
12 |
$295.00 |
| D0602 |
|
12 |
12 |
$120.00 |