| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,807 |
8,769 |
$483K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,589 |
2,993 |
$442K |
| D1120 |
Prophylaxis - child |
11,083 |
11,041 |
$428K |
| D2140 |
|
3,243 |
1,707 |
$177K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,185 |
11,141 |
$148K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,236 |
2,916 |
$128K |
| D0274 |
Bitewings - four radiographic images |
5,819 |
5,796 |
$124K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,115 |
1,216 |
$121K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,814 |
1,813 |
$117K |
| D1310 |
|
2,545 |
2,534 |
$116K |
| D2160 |
|
1,370 |
852 |
$109K |
| D1351 |
Sealant - per tooth |
3,726 |
1,182 |
$94K |
| D9993 |
|
1,387 |
1,386 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,822 |
10,644 |
$83K |
| D0350 |
|
6,712 |
3,273 |
$72K |
| D0272 |
Bitewings - two radiographic images |
3,516 |
3,504 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,212 |
2,151 |
$26K |
| D0603 |
|
1,703 |
1,695 |
$25K |
| D0145 |
Oral evaluation for a patient under three years of age |
306 |
303 |
$18K |
| D1354 |
|
372 |
303 |
$10K |
| D0601 |
|
409 |
409 |
$6K |
| D9430 |
|
106 |
106 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
20 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
28 |
28 |
$840.00 |