| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
15,849 |
15,579 |
$443K |
| D0120 |
Periodic oral evaluation - established patient |
16,009 |
15,703 |
$442K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,925 |
2,354 |
$268K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,939 |
11,847 |
$212K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,142 |
7,363 |
$148K |
| D1206 |
Topical application of fluoride varnish |
5,305 |
5,080 |
$99K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
567 |
219 |
$70K |
| D0272 |
Bitewings - two radiographic images |
7,808 |
7,678 |
$61K |
| D1110 |
Prophylaxis - adult |
1,855 |
1,796 |
$55K |
| D2140 |
|
915 |
655 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
1,173 |
1,157 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
7,293 |
7,121 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,099 |
1,097 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
658 |
389 |
$34K |
| D0603 |
|
4,086 |
4,007 |
$33K |
| D0602 |
|
4,128 |
4,041 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,995 |
4,737 |
$31K |
| D0601 |
|
2,453 |
2,393 |
$19K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
263 |
162 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
165 |
111 |
$13K |
| D0274 |
Bitewings - four radiographic images |
429 |
405 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
72 |
49 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
253 |
247 |
$3K |
| D2160 |
|
19 |
14 |
$1K |
| D2331 |
|
15 |
12 |
$1K |
| D1999 |
|
72 |
72 |
$0.00 |