| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,496 |
8,470 |
$478K |
| D1120 |
Prophylaxis - child |
8,972 |
8,942 |
$352K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,550 |
2,453 |
$305K |
| D0230 |
Intraoral - periapical each additional radiographic image |
66,823 |
10,383 |
$279K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,650 |
9,613 |
$125K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,732 |
1,721 |
$110K |
| D0274 |
Bitewings - four radiographic images |
4,921 |
4,896 |
$106K |
| D2140 |
|
1,744 |
1,118 |
$95K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,800 |
1,683 |
$72K |
| D1351 |
Sealant - per tooth |
2,082 |
761 |
$57K |
| D1310 |
|
1,156 |
1,153 |
$53K |
| D2160 |
|
619 |
422 |
$49K |
| D7240 |
Removal of impacted tooth - completely bony |
210 |
96 |
$49K |
| D0350 |
|
4,212 |
2,333 |
$44K |
| D9993 |
|
629 |
629 |
$41K |
| D9430 |
|
1,060 |
1,045 |
$34K |
| D4341 |
|
450 |
122 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,532 |
2,505 |
$30K |
| D0272 |
Bitewings - two radiographic images |
2,480 |
2,473 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
482 |
278 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
154 |
92 |
$18K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
140 |
67 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
325 |
324 |
$15K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
140 |
67 |
$14K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
18 |
14 |
$9K |
| D0603 |
|
447 |
447 |
$7K |
| D1110 |
Prophylaxis - adult |
50 |
50 |
$4K |
| D2954 |
|
32 |
27 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
90 |
90 |
$3K |
| D0330 |
Panoramic radiographic image |
62 |
62 |
$2K |
| D2330 |
|
18 |
15 |
$1K |
| D0602 |
|
26 |
26 |
$390.00 |