| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,833 |
8,807 |
$211K |
| D1120 |
Prophylaxis - child |
6,214 |
6,195 |
$149K |
| D1110 |
Prophylaxis - adult |
3,714 |
3,699 |
$137K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,316 |
1,539 |
$128K |
| D0274 |
Bitewings - four radiographic images |
2,744 |
2,735 |
$81K |
| D1351 |
Sealant - per tooth |
3,687 |
1,099 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,973 |
4,956 |
$75K |
| D2140 |
|
1,635 |
1,188 |
$68K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
463 |
187 |
$62K |
| D1206 |
Topical application of fluoride varnish |
2,665 |
2,658 |
$61K |
| D0272 |
Bitewings - two radiographic images |
2,703 |
2,697 |
$61K |
| D0330 |
Panoramic radiographic image |
1,111 |
1,108 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,002 |
659 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,330 |
1,327 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,564 |
2,288 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
515 |
514 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,393 |
1,378 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
108 |
70 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
574 |
497 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
25 |
$2K |
| D2331 |
|
18 |
12 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
24 |
$1K |