| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,733 |
13,712 |
$881K |
| D1120 |
Prophylaxis - child |
19,291 |
19,258 |
$807K |
| D0230 |
Intraoral - periapical each additional radiographic image |
73,860 |
16,126 |
$309K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,729 |
18,700 |
$303K |
| D1310 |
|
5,809 |
5,798 |
$265K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,779 |
3,774 |
$251K |
| D1351 |
Sealant - per tooth |
7,268 |
1,608 |
$243K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,404 |
1,446 |
$226K |
| D0220 |
Intraoral - periapical first radiographic image |
16,031 |
15,944 |
$192K |
| D9993 |
|
2,614 |
2,608 |
$163K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,320 |
2,319 |
$149K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,527 |
2,403 |
$100K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,765 |
1,133 |
$100K |
| D0601 |
|
3,892 |
3,880 |
$58K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
441 |
310 |
$51K |
| D9430 |
|
1,421 |
1,393 |
$45K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
425 |
300 |
$42K |
| D0603 |
|
1,798 |
1,788 |
$26K |
| D0272 |
Bitewings - two radiographic images |
927 |
921 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
74 |
31 |
$5K |
| D1999 |
|
1,686 |
1,685 |
$20.00 |