| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,003 |
9,975 |
$553K |
| D1120 |
Prophylaxis - child |
10,761 |
10,735 |
$416K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,762 |
2,029 |
$247K |
| D0230 |
Intraoral - periapical each additional radiographic image |
50,707 |
9,979 |
$243K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,608 |
10,580 |
$129K |
| D1351 |
Sealant - per tooth |
4,778 |
1,224 |
$125K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,375 |
1,435 |
$124K |
| D0210 |
Intraoral - complete series of radiographic images |
2,550 |
2,544 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,743 |
1,742 |
$110K |
| D0274 |
Bitewings - four radiographic images |
4,770 |
4,747 |
$100K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
820 |
339 |
$81K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,322 |
770 |
$75K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,829 |
1,814 |
$72K |
| D1110 |
Prophylaxis - adult |
483 |
480 |
$42K |
| D0350 |
|
3,989 |
2,300 |
$42K |
| D0272 |
Bitewings - two radiographic images |
3,382 |
3,377 |
$39K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
322 |
182 |
$37K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
392 |
217 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,032 |
1,995 |
$24K |
| D1310 |
|
388 |
387 |
$18K |
| D9430 |
|
534 |
523 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
160 |
115 |
$13K |
| D2140 |
|
192 |
119 |
$10K |
| D4910 |
|
51 |
51 |
$4K |
| D0603 |
|
164 |
164 |
$2K |
| D2330 |
|
20 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
26 |
26 |
$728.00 |
| D0602 |
|
13 |
13 |
$195.00 |