| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,390 |
4,151 |
$657K |
| D1120 |
Prophylaxis - child |
9,414 |
9,413 |
$373K |
| D0120 |
Periodic oral evaluation - established patient |
9,586 |
9,586 |
$262K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,937 |
2,158 |
$232K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,952 |
10,951 |
$155K |
| D1351 |
Sealant - per tooth |
2,761 |
815 |
$102K |
| D1110 |
Prophylaxis - adult |
1,868 |
1,868 |
$100K |
| D0272 |
Bitewings - two radiographic images |
3,154 |
3,153 |
$66K |
| D0330 |
Panoramic radiographic image |
1,164 |
1,164 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,371 |
1,371 |
$52K |
| D9920 |
|
2,006 |
1,964 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
472 |
419 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,651 |
1,650 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
630 |
400 |
$29K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
166 |
135 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
223 |
202 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
145 |
118 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
118 |
97 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
668 |
658 |
$9K |
| D9997 |
|
290 |
288 |
$6K |
| D2140 |
|
35 |
28 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
15 |
$370.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$114.00 |