| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
26,371 |
26,251 |
$1.47M |
| D1120 |
Prophylaxis - child |
30,210 |
30,067 |
$1.17M |
| D1351 |
Sealant - per tooth |
31,829 |
8,926 |
$897K |
| D0274 |
Bitewings - four radiographic images |
22,288 |
22,183 |
$471K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,691 |
2,409 |
$313K |
| D0230 |
Intraoral - periapical each additional radiographic image |
68,681 |
28,986 |
$293K |
| D1208 |
Topical application of fluoride, excluding varnish |
25,933 |
25,817 |
$272K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,394 |
3,386 |
$209K |
| D1310 |
|
4,352 |
4,341 |
$199K |
| D9993 |
|
2,648 |
2,648 |
$167K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,956 |
3,622 |
$155K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,254 |
665 |
$146K |
| D1206 |
Topical application of fluoride varnish |
4,452 |
4,440 |
$93K |
| D2140 |
|
1,447 |
910 |
$78K |
| D7111 |
|
1,294 |
984 |
$74K |
| D0272 |
Bitewings - two radiographic images |
5,377 |
5,357 |
$63K |
| D2160 |
|
785 |
569 |
$62K |
| D9430 |
|
1,715 |
1,653 |
$54K |
| D0350 |
|
3,932 |
2,234 |
$50K |
| D0603 |
|
3,314 |
3,302 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,503 |
3,390 |
$41K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
317 |
168 |
$32K |
| D0145 |
Oral evaluation for a patient under three years of age |
475 |
474 |
$26K |
| D2335 |
|
153 |
67 |
$18K |
| D0602 |
|
814 |
813 |
$12K |
| D2330 |
|
114 |
69 |
$9K |
| D1354 |
|
323 |
205 |
$7K |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$1K |
| D1999 |
|
308 |
306 |
$160.00 |