| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2140 |
|
3,560 |
1,637 |
$192K |
| D0120 |
Periodic oral evaluation - established patient |
3,639 |
3,638 |
$171K |
| D1120 |
Prophylaxis - child |
3,868 |
3,864 |
$123K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,241 |
4,889 |
$108K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,766 |
1,713 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,144 |
1,143 |
$68K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
750 |
510 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,409 |
4,405 |
$49K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
415 |
314 |
$47K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
474 |
342 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,956 |
1,956 |
$41K |
| D9993 |
|
624 |
624 |
$40K |
| D0350 |
|
3,459 |
2,058 |
$35K |
| D1310 |
|
694 |
694 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
542 |
541 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,490 |
1,488 |
$17K |
| D1110 |
Prophylaxis - adult |
149 |
149 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
174 |
128 |
$10K |
| D7111 |
|
139 |
104 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
23 |
12 |
$3K |
| D0602 |
|
135 |
135 |
$2K |
| D0603 |
|
128 |
128 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
114 |
113 |
$1K |
| D4910 |
|
15 |
15 |
$1K |
| D1351 |
Sealant - per tooth |
31 |
12 |
$682.00 |