| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
4,489 |
4,412 |
$265K |
| D1120 |
Prophylaxis - child |
5,413 |
5,348 |
$196K |
| D0120 |
Periodic oral evaluation - established patient |
6,638 |
6,539 |
$185K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,952 |
995 |
$181K |
| D1110 |
Prophylaxis - adult |
3,233 |
3,177 |
$161K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,294 |
5,236 |
$110K |
| D9248 |
|
674 |
590 |
$86K |
| D0272 |
Bitewings - two radiographic images |
3,684 |
3,631 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,447 |
1,407 |
$74K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,866 |
1,757 |
$69K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
663 |
341 |
$55K |
| D2160 |
|
327 |
203 |
$37K |
| D1206 |
Topical application of fluoride varnish |
1,280 |
1,264 |
$33K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
149 |
73 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
443 |
387 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
44 |
24 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
73 |
72 |
$4K |
| D7111 |
|
55 |
26 |
$3K |
| D1351 |
Sealant - per tooth |
102 |
27 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
129 |
125 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
12 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$1K |