| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,872 |
10,715 |
$1.10M |
| D1120 |
Prophylaxis - child |
16,270 |
16,127 |
$446K |
| D0272 |
Bitewings - two radiographic images |
7,087 |
6,931 |
$233K |
| D1351 |
Sealant - per tooth |
8,829 |
1,642 |
$172K |
| D0220 |
Intraoral - periapical first radiographic image |
8,320 |
8,176 |
$164K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,090 |
1,060 |
$125K |
| D1206 |
Topical application of fluoride varnish |
17,143 |
16,928 |
$114K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
930 |
834 |
$96K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,556 |
7,806 |
$71K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,523 |
1,286 |
$56K |
| D2140 |
|
1,361 |
750 |
$37K |
| D0274 |
Bitewings - four radiographic images |
2,348 |
2,325 |
$35K |
| D0330 |
Panoramic radiographic image |
2,311 |
2,270 |
$35K |
| D9420 |
|
300 |
291 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
232 |
153 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
154 |
100 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
504 |
277 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
272 |
260 |
$12K |
| D1110 |
Prophylaxis - adult |
243 |
241 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
18 |
12 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
86 |
30 |
$2K |
| D2331 |
|
49 |
28 |
$2K |
| D4355 |
|
81 |
78 |
$472.72 |