| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,789 |
7,727 |
$395K |
| D1120 |
Prophylaxis - child |
7,947 |
7,877 |
$284K |
| D1310 |
|
2,578 |
2,555 |
$117K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,227 |
8,152 |
$97K |
| D9993 |
|
1,618 |
1,618 |
$97K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
587 |
472 |
$67K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,687 |
1,621 |
$66K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
477 |
396 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
718 |
707 |
$45K |
| D0145 |
Oral evaluation for a patient under three years of age |
702 |
702 |
$42K |
| D0272 |
Bitewings - two radiographic images |
3,303 |
3,271 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
523 |
367 |
$35K |
| D1351 |
Sealant - per tooth |
739 |
203 |
$28K |
| D0603 |
|
1,403 |
1,395 |
$21K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
275 |
182 |
$18K |
| D0601 |
|
938 |
924 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,167 |
1,469 |
$13K |
| D0274 |
Bitewings - four radiographic images |
510 |
498 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
107 |
77 |
$6K |
| D0330 |
Panoramic radiographic image |
140 |
139 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
69 |
41 |
$4K |
| D1206 |
Topical application of fluoride varnish |
143 |
142 |
$3K |
| D0602 |
|
106 |
106 |
$2K |
| D1354 |
|
25 |
25 |
$875.00 |
| D0220 |
Intraoral - periapical first radiographic image |
43 |
43 |
$488.00 |
| D9430 |
|
13 |
13 |
$416.00 |
| D0350 |
|
59 |
34 |
$384.00 |