| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,179 |
10,172 |
$348K |
| D0120 |
Periodic oral evaluation - established patient |
5,174 |
5,169 |
$295K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,766 |
3,765 |
$248K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,066 |
1,071 |
$243K |
| D1310 |
|
4,100 |
4,096 |
$184K |
| D9993 |
|
2,843 |
2,841 |
$168K |
| D1206 |
Topical application of fluoride varnish |
10,188 |
10,180 |
$151K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31,195 |
8,261 |
$150K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,276 |
3,053 |
$129K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,739 |
945 |
$116K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,907 |
1,047 |
$108K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,455 |
1,455 |
$91K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,114 |
690 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
4,549 |
4,501 |
$54K |
| D1351 |
Sealant - per tooth |
2,013 |
724 |
$53K |
| D0603 |
|
3,145 |
3,143 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
794 |
470 |
$42K |
| D9430 |
|
891 |
866 |
$28K |
| D2330 |
|
352 |
232 |
$26K |
| D0274 |
Bitewings - four radiographic images |
2,289 |
2,250 |
$23K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
39 |
25 |
$19K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
160 |
133 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,316 |
1,304 |
$15K |
| D0602 |
|
640 |
638 |
$9K |
| D0240 |
|
698 |
439 |
$8K |
| D2140 |
|
71 |
59 |
$4K |
| D9222 |
|
25 |
25 |
$3K |
| D0270 |
|
376 |
375 |
$2K |
| D9610 |
|
26 |
24 |
$2K |
| D0601 |
|
101 |
101 |
$2K |
| D2160 |
|
17 |
13 |
$1K |
| D3120 |
|
851 |
594 |
$0.00 |
| D1330 |
|
7,260 |
7,254 |
$0.00 |