| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,553 |
16,522 |
$683K |
| D0120 |
Periodic oral evaluation - established patient |
10,265 |
10,244 |
$642K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,004 |
1,396 |
$473K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,148 |
1,377 |
$410K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,817 |
2,054 |
$385K |
| D1351 |
Sealant - per tooth |
12,305 |
3,796 |
$375K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,802 |
2,695 |
$273K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,120 |
4,098 |
$259K |
| D0230 |
Intraoral - periapical each additional radiographic image |
64,065 |
14,880 |
$256K |
| D1310 |
|
4,994 |
4,992 |
$229K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,764 |
10,730 |
$176K |
| D2140 |
|
2,817 |
1,544 |
$152K |
| D0220 |
Intraoral - periapical first radiographic image |
12,547 |
12,336 |
$149K |
| D9993 |
|
2,135 |
2,134 |
$135K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,562 |
1,558 |
$92K |
| D1206 |
Topical application of fluoride varnish |
6,495 |
6,491 |
$84K |
| D0603 |
|
4,952 |
4,949 |
$74K |
| D9248 |
|
1,974 |
1,956 |
$68K |
| D9430 |
|
1,997 |
1,927 |
$62K |
| D0272 |
Bitewings - two radiographic images |
3,897 |
3,884 |
$45K |
| D0350 |
|
4,431 |
2,510 |
$45K |
| D1110 |
Prophylaxis - adult |
283 |
281 |
$25K |
| D2330 |
|
248 |
129 |
$18K |
| D9920 |
|
77 |
72 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
119 |
114 |
$4K |
| D0330 |
Panoramic radiographic image |
44 |
44 |
$1K |
| D0602 |
|
17 |
17 |
$255.00 |
| D1999 |
|
157 |
153 |
$46.00 |