| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,102 |
5,951 |
$327K |
| D0120 |
Periodic oral evaluation - established patient |
6,446 |
6,130 |
$261K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,865 |
2,582 |
$204K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,105 |
4,989 |
$159K |
| D7140 |
Extraction, erupted tooth or exposed root |
689 |
411 |
$111K |
| D1110 |
Prophylaxis - adult |
1,417 |
1,379 |
$100K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
629 |
363 |
$99K |
| D0272 |
Bitewings - two radiographic images |
2,014 |
1,959 |
$74K |
| D1206 |
Topical application of fluoride varnish |
2,177 |
2,111 |
$70K |
| D9110 |
|
535 |
500 |
$62K |
| D0274 |
Bitewings - four radiographic images |
1,149 |
1,122 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
2,314 |
2,203 |
$55K |
| D1351 |
Sealant - per tooth |
1,130 |
356 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
191 |
139 |
$44K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
169 |
94 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,000 |
734 |
$26K |
| D0330 |
Panoramic radiographic image |
167 |
163 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
71 |
41 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
193 |
168 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
24 |
$5K |
| D2160 |
|
19 |
13 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
52 |
49 |
$3K |
| D0240 |
|
14 |
12 |
$485.52 |
| D0603 |
|
2,421 |
2,335 |
$0.00 |
| D0601 |
|
3,266 |
3,169 |
$0.00 |
| D0602 |
|
1,214 |
1,182 |
$0.00 |