| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,440 |
5,433 |
$264K |
| D1120 |
Prophylaxis - child |
6,752 |
6,737 |
$231K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32,034 |
6,342 |
$133K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,468 |
739 |
$98K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,728 |
6,718 |
$81K |
| D9993 |
|
1,060 |
1,060 |
$68K |
| D1310 |
|
1,427 |
1,425 |
$64K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
935 |
489 |
$62K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
511 |
263 |
$59K |
| D0274 |
Bitewings - four radiographic images |
2,348 |
2,345 |
$50K |
| D2140 |
|
767 |
424 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
723 |
421 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
477 |
476 |
$29K |
| D1351 |
Sealant - per tooth |
1,163 |
463 |
$29K |
| D0350 |
|
2,474 |
1,380 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
356 |
203 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,546 |
1,542 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
427 |
414 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,397 |
1,394 |
$16K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
166 |
83 |
$16K |
| D0603 |
|
821 |
820 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
113 |
77 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
138 |
138 |
$8K |
| D0602 |
|
283 |
283 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
100 |
100 |
$4K |
| D2160 |
|
21 |
14 |
$2K |
| D1330 |
|
14 |
14 |
$0.00 |