| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
17,617 |
17,195 |
$1.45M |
| D0220 |
Intraoral - periapical first radiographic image |
3,208 |
3,056 |
$206K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,116 |
2,012 |
$196K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,203 |
2,202 |
$169K |
| D1351 |
Sealant - per tooth |
4,849 |
1,120 |
$162K |
| D1120 |
Prophylaxis - child |
18,024 |
17,511 |
$146K |
| D0272 |
Bitewings - two radiographic images |
16,161 |
15,702 |
$145K |
| D1206 |
Topical application of fluoride varnish |
17,855 |
17,459 |
$80K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,143 |
639 |
$79K |
| D2140 |
|
2,299 |
1,365 |
$78K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,672 |
927 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
705 |
666 |
$29K |
| D0330 |
Panoramic radiographic image |
1,452 |
1,419 |
$26K |
| D9420 |
|
123 |
120 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
408 |
251 |
$24K |
| D1110 |
Prophylaxis - adult |
1,835 |
1,787 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
935 |
292 |
$17K |
| D0274 |
Bitewings - four radiographic images |
411 |
411 |
$15K |
| D2160 |
|
255 |
179 |
$11K |
| D2332 |
|
208 |
97 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,755 |
1,673 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
156 |
90 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
38 |
32 |
$3K |
| D1510 |
|
41 |
24 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,271 |
1,204 |
$309.40 |