| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,932 |
8,911 |
$452K |
| D0120 |
Periodic oral evaluation - established patient |
4,310 |
4,294 |
$301K |
| D1351 |
Sealant - per tooth |
7,800 |
2,327 |
$278K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,518 |
1,768 |
$236K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,413 |
3,405 |
$230K |
| D1310 |
|
4,549 |
4,537 |
$206K |
| D0230 |
Intraoral - periapical each additional radiographic image |
51,798 |
8,228 |
$203K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,954 |
8,933 |
$187K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,713 |
3,671 |
$148K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,120 |
414 |
$134K |
| D2140 |
|
2,160 |
1,314 |
$118K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,596 |
831 |
$91K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
777 |
279 |
$77K |
| D0603 |
|
3,751 |
3,740 |
$56K |
| D0274 |
Bitewings - four radiographic images |
2,392 |
2,382 |
$51K |
| D0145 |
Oral evaluation for a patient under three years of age |
729 |
729 |
$50K |
| D2330 |
|
582 |
297 |
$46K |
| D0350 |
|
4,276 |
2,174 |
$46K |
| D0272 |
Bitewings - two radiographic images |
2,642 |
2,638 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,566 |
2,545 |
$29K |
| D2160 |
|
235 |
161 |
$19K |
| D9993 |
|
198 |
198 |
$12K |
| D1320 |
|
1,163 |
1,163 |
$9K |
| D0602 |
|
236 |
236 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$624.00 |
| D0601 |
|
42 |
42 |
$555.00 |