| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,536 |
7,520 |
$407K |
| D1120 |
Prophylaxis - child |
9,033 |
9,002 |
$326K |
| D1351 |
Sealant - per tooth |
4,640 |
1,175 |
$127K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,055 |
2,019 |
$80K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,159 |
694 |
$73K |
| D0272 |
Bitewings - two radiographic images |
6,332 |
6,311 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,695 |
8,007 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,874 |
3,844 |
$58K |
| D1310 |
|
1,213 |
1,212 |
$53K |
| D1206 |
Topical application of fluoride varnish |
4,910 |
4,908 |
$53K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
633 |
360 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
681 |
677 |
$38K |
| D9993 |
|
612 |
612 |
$30K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
232 |
175 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,101 |
1,101 |
$22K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
229 |
172 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
416 |
415 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
141 |
94 |
$7K |
| D0603 |
|
496 |
494 |
$7K |
| D0602 |
|
369 |
369 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
384 |
381 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
138 |
138 |
$4K |
| D9430 |
|
62 |
62 |
$2K |
| D2140 |
|
22 |
16 |
$1K |