| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,979 |
3,967 |
$207K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,674 |
1,153 |
$177K |
| D1120 |
Prophylaxis - child |
4,702 |
4,681 |
$168K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,410 |
2,401 |
$142K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,280 |
5,818 |
$130K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,433 |
628 |
$81K |
| D0272 |
Bitewings - two radiographic images |
5,514 |
5,495 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,274 |
5,251 |
$60K |
| D2140 |
|
722 |
375 |
$39K |
| D1351 |
Sealant - per tooth |
1,488 |
362 |
$38K |
| D2160 |
|
440 |
267 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,388 |
2,261 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
541 |
541 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
512 |
502 |
$20K |
| D0350 |
|
1,040 |
944 |
$17K |
| D1110 |
Prophylaxis - adult |
169 |
168 |
$14K |
| D9993 |
|
203 |
203 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
117 |
51 |
$11K |
| D1310 |
|
220 |
220 |
$10K |
| D4341 |
|
107 |
44 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
49 |
26 |
$6K |
| D9430 |
|
135 |
134 |
$4K |
| D0601 |
|
26 |
26 |
$390.00 |
| D0602 |
|
13 |
13 |
$187.50 |