| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,664 |
7,532 |
$212K |
| D0120 |
Periodic oral evaluation - established patient |
10,712 |
10,507 |
$197K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,750 |
12,436 |
$182K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,111 |
1,951 |
$182K |
| D1999 |
|
8,899 |
7,610 |
$163K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,408 |
864 |
$130K |
| D1110 |
Prophylaxis - adult |
3,689 |
3,558 |
$124K |
| D0330 |
Panoramic radiographic image |
2,278 |
2,214 |
$106K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,722 |
4,101 |
$98K |
| D2140 |
|
1,899 |
1,458 |
$89K |
| D0272 |
Bitewings - two radiographic images |
4,189 |
4,097 |
$73K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,320 |
912 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,038 |
1,931 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
882 |
832 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,237 |
2,089 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
240 |
145 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
838 |
807 |
$18K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
135 |
88 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
82 |
59 |
$6K |
| D1351 |
Sealant - per tooth |
108 |
27 |
$2K |
| D3120 |
|
42 |
28 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
96 |
66 |
$829.50 |