| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,786 |
6,715 |
$418K |
| D1120 |
Prophylaxis - child |
10,058 |
9,942 |
$401K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,972 |
1,225 |
$345K |
| D1206 |
Topical application of fluoride varnish |
10,108 |
9,995 |
$167K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35,133 |
8,316 |
$152K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,381 |
1,585 |
$135K |
| D1351 |
Sealant - per tooth |
4,680 |
1,474 |
$134K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,041 |
2,030 |
$132K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,712 |
2,606 |
$107K |
| D1310 |
|
3,380 |
3,329 |
$105K |
| D9110 |
|
1,616 |
1,535 |
$101K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,360 |
789 |
$89K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,415 |
1,410 |
$85K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,219 |
605 |
$81K |
| D0272 |
Bitewings - two radiographic images |
6,776 |
6,705 |
$79K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
541 |
286 |
$52K |
| D2330 |
|
503 |
287 |
$37K |
| D0603 |
|
3,081 |
3,031 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,764 |
2,684 |
$31K |
| D9430 |
|
370 |
346 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
192 |
191 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
126 |
85 |
$6K |
| D9993 |
|
364 |
364 |
$6K |
| D2160 |
|
61 |
42 |
$5K |
| D2140 |
|
33 |
16 |
$2K |
| D2332 |
|
22 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$455.00 |
| D0270 |
|
30 |
28 |
$140.00 |
| D9920 |
|
429 |
425 |
$140.00 |
| D0350 |
|
98 |
48 |
$138.00 |
| D0602 |
|
67 |
66 |
$105.00 |