| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,804 |
3,797 |
$244K |
| D1120 |
Prophylaxis - child |
5,425 |
5,409 |
$236K |
| D1310 |
|
2,610 |
2,594 |
$119K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,558 |
5,170 |
$111K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,338 |
5,321 |
$92K |
| D1351 |
Sealant - per tooth |
2,256 |
825 |
$70K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,664 |
1,509 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
941 |
939 |
$62K |
| D9993 |
|
898 |
893 |
$57K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
796 |
443 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,614 |
1,614 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,314 |
2,191 |
$27K |
| D0603 |
|
1,522 |
1,515 |
$23K |
| D0350 |
|
1,720 |
1,036 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,536 |
1,528 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
264 |
172 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
173 |
173 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
193 |
114 |
$11K |
| D0602 |
|
693 |
685 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
49 |
26 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
51 |
25 |
$5K |
| D2330 |
|
47 |
30 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
25 |
$2K |
| D2140 |
|
27 |
14 |
$1K |
| D1320 |
|
33 |
33 |
$330.00 |