| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,957 |
13,786 |
$429K |
| D1120 |
Prophylaxis - child |
11,091 |
10,929 |
$426K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,697 |
1,689 |
$388K |
| D1206 |
Topical application of fluoride varnish |
16,137 |
15,908 |
$319K |
| D1110 |
Prophylaxis - adult |
5,566 |
5,479 |
$307K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,515 |
5,100 |
$256K |
| D1351 |
Sealant - per tooth |
7,217 |
2,369 |
$230K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
735 |
304 |
$142K |
| D0272 |
Bitewings - two radiographic images |
5,116 |
5,024 |
$137K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,222 |
765 |
$124K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,013 |
562 |
$121K |
| D0330 |
Panoramic radiographic image |
2,180 |
2,099 |
$106K |
| D0274 |
Bitewings - four radiographic images |
2,832 |
2,795 |
$97K |
| D2140 |
|
940 |
651 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,415 |
1,368 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
654 |
396 |
$65K |
| D1354 |
|
2,054 |
620 |
$57K |
| D2160 |
|
222 |
135 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
487 |
468 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,222 |
1,156 |
$14K |
| D2331 |
|
94 |
50 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
78 |
51 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
418 |
343 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
49 |
48 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
13 |
$2K |
| D9987 |
|
1,783 |
1,689 |
$5.00 |
| D9986 |
|
883 |
853 |
$0.00 |
| D0180 |
|
13 |
13 |
$0.00 |
| D0603 |
|
167 |
138 |
$0.00 |