| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
14,202 |
14,107 |
$940K |
| D1120 |
Prophylaxis - child |
20,533 |
20,420 |
$901K |
| D1310 |
|
8,935 |
8,912 |
$400K |
| D1206 |
Topical application of fluoride varnish |
20,364 |
20,253 |
$355K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,123 |
5,094 |
$341K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,855 |
1,424 |
$178K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,493 |
2,490 |
$173K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,519 |
1,121 |
$134K |
| D0601 |
|
8,915 |
8,890 |
$129K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,713 |
2,554 |
$106K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
845 |
613 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
7,987 |
7,443 |
$91K |
| D9993 |
|
4,409 |
4,391 |
$90K |
| D2160 |
|
1,169 |
736 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,893 |
10,111 |
$86K |
| D2330 |
|
1,068 |
365 |
$77K |
| D9430 |
|
2,261 |
2,170 |
$68K |
| D0330 |
Panoramic radiographic image |
2,374 |
2,357 |
$67K |
| D1351 |
Sealant - per tooth |
2,342 |
612 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,068 |
691 |
$58K |
| D0274 |
Bitewings - four radiographic images |
2,102 |
2,084 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
651 |
320 |
$41K |
| D0272 |
Bitewings - two radiographic images |
3,356 |
3,331 |
$39K |
| D2331 |
|
426 |
165 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
413 |
186 |
$21K |
| D2140 |
|
150 |
96 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
170 |
169 |
$7K |
| D9110 |
|
102 |
101 |
$6K |
| D1110 |
Prophylaxis - adult |
27 |
27 |
$2K |
| D0350 |
|
299 |
126 |
$2K |
| D2332 |
|
20 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
17 |
$1K |
| D1330 |
|
135 |
132 |
$0.00 |
| D0190 |
|
61 |
27 |
$0.00 |
| D1999 |
|
156 |
155 |
$0.00 |