| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
47,394 |
47,055 |
$1.62M |
| D7140 |
Extraction, erupted tooth or exposed root |
20,009 |
10,216 |
$1.55M |
| D1206 |
Topical application of fluoride varnish |
57,520 |
57,039 |
$1.52M |
| D1120 |
Prophylaxis - child |
36,465 |
36,178 |
$1.30M |
| D0330 |
Panoramic radiographic image |
13,260 |
13,152 |
$1.15M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,813 |
3,436 |
$1.13M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17,567 |
11,053 |
$1.12M |
| D1110 |
Prophylaxis - adult |
21,922 |
21,747 |
$1.08M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,111 |
7,472 |
$863K |
| D0220 |
Intraoral - periapical first radiographic image |
49,445 |
48,560 |
$821K |
| D1351 |
Sealant - per tooth |
24,263 |
8,757 |
$787K |
| D0274 |
Bitewings - four radiographic images |
20,184 |
20,015 |
$770K |
| D1330 |
|
26,220 |
25,857 |
$745K |
| D0230 |
Intraoral - periapical each additional radiographic image |
57,590 |
39,498 |
$728K |
| D1354 |
|
17,063 |
2,823 |
$559K |
| D0272 |
Bitewings - two radiographic images |
17,223 |
17,090 |
$558K |
| D0240 |
|
17,644 |
8,975 |
$544K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,645 |
11,531 |
$472K |
| D0140 |
Limited oral evaluation - problem focused |
11,798 |
11,413 |
$386K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,590 |
2,628 |
$200K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,706 |
8,899 |
$177K |
| D2140 |
|
3,511 |
2,314 |
$159K |
| D2331 |
|
1,429 |
1,058 |
$105K |
| D2335 |
|
1,161 |
874 |
$103K |
| D2934 |
|
439 |
106 |
$102K |
| D2330 |
|
1,683 |
1,110 |
$91K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,032 |
729 |
$76K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,298 |
736 |
$69K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,634 |
1,621 |
$59K |
| D2160 |
|
844 |
720 |
$55K |
| D2332 |
|
528 |
421 |
$38K |
| D9920 |
|
1,070 |
992 |
$29K |
| D5212 |
|
39 |
39 |
$27K |
| D5110 |
|
41 |
41 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
254 |
230 |
$20K |
| D4341 |
|
95 |
36 |
$19K |
| D9420 |
|
567 |
472 |
$17K |
| D0190 |
|
789 |
781 |
$12K |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
306 |
270 |
$9K |
| D2940 |
|
122 |
69 |
$8K |
| D7250 |
|
38 |
24 |
$5K |
| D9410 |
|
84 |
84 |
$3K |
| D4910 |
|
26 |
25 |
$2K |
| D2161 |
|
15 |
13 |
$868.32 |
| D4355 |
|
41 |
39 |
$703.05 |
| D9430 |
|
45 |
44 |
$292.89 |
| D9985 |
|
142 |
140 |
$0.00 |
| D1999 |
|
17 |
14 |
$0.00 |