| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
19,255 |
19,071 |
$831K |
| D0120 |
Periodic oral evaluation - established patient |
12,508 |
12,381 |
$805K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,146 |
1,976 |
$737K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
10,698 |
4,726 |
$718K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,111 |
1,964 |
$607K |
| D2140 |
|
9,511 |
4,903 |
$519K |
| D0230 |
Intraoral - periapical each additional radiographic image |
102,324 |
19,644 |
$450K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,802 |
3,999 |
$447K |
| D1310 |
|
8,942 |
8,810 |
$403K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,437 |
5,410 |
$368K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,989 |
19,797 |
$354K |
| D1351 |
Sealant - per tooth |
11,139 |
4,194 |
$332K |
| D9993 |
|
2,289 |
2,280 |
$146K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,179 |
2,156 |
$144K |
| D0220 |
Intraoral - periapical first radiographic image |
11,370 |
11,143 |
$134K |
| D2160 |
|
1,604 |
1,091 |
$128K |
| D0350 |
|
11,298 |
5,788 |
$121K |
| D0603 |
|
8,106 |
7,986 |
$119K |
| D0272 |
Bitewings - two radiographic images |
9,482 |
9,435 |
$112K |
| D2330 |
|
1,230 |
801 |
$95K |
| D1510 |
|
163 |
131 |
$22K |
| D1110 |
Prophylaxis - adult |
211 |
211 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
231 |
231 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
256 |
255 |
$10K |
| D8670 |
Periodic orthodontic treatment visit |
32 |
32 |
$9K |
| D2331 |
|
81 |
53 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
171 |
171 |
$6K |
| D0602 |
|
338 |
325 |
$5K |
| D0340 |
|
91 |
91 |
$5K |
| D0330 |
Panoramic radiographic image |
125 |
125 |
$4K |
| D9430 |
|
26 |
26 |
$832.00 |
| D0601 |
|
41 |
39 |
$615.00 |