| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,595 |
1,106 |
$402K |
| D1120 |
Prophylaxis - child |
7,081 |
6,936 |
$366K |
| D0120 |
Periodic oral evaluation - established patient |
8,037 |
7,715 |
$309K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,354 |
735 |
$285K |
| D1206 |
Topical application of fluoride varnish |
8,514 |
8,314 |
$274K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,896 |
5,194 |
$160K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,341 |
2,199 |
$150K |
| D0220 |
Intraoral - periapical first radiographic image |
5,938 |
5,781 |
$139K |
| D1110 |
Prophylaxis - adult |
1,791 |
1,739 |
$118K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
466 |
167 |
$114K |
| D0274 |
Bitewings - four radiographic images |
2,052 |
2,005 |
$104K |
| D0272 |
Bitewings - two radiographic images |
2,689 |
2,649 |
$97K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
396 |
215 |
$63K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
394 |
210 |
$56K |
| D0330 |
Panoramic radiographic image |
565 |
556 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
692 |
638 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
759 |
713 |
$44K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
223 |
89 |
$40K |
| D0160 |
|
235 |
220 |
$27K |
| D8670 |
Periodic orthodontic treatment visit |
80 |
25 |
$11K |
| D1351 |
Sealant - per tooth |
200 |
41 |
$9K |
| D9920 |
|
47 |
38 |
$5K |
| D0602 |
|
2,014 |
1,950 |
$0.00 |
| D0603 |
|
7,098 |
6,914 |
$0.00 |
| D9420 |
|
90 |
88 |
$0.00 |