| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
37,774 |
36,037 |
$1.50M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13,585 |
5,154 |
$1.30M |
| D0210 |
Intraoral - complete series of radiographic images |
10,756 |
10,068 |
$880K |
| D1110 |
Prophylaxis - adult |
11,979 |
11,500 |
$659K |
| D9248 |
|
9,305 |
8,344 |
$548K |
| D0240 |
|
28,671 |
18,135 |
$323K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,505 |
2,611 |
$281K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,653 |
4,309 |
$251K |
| D1351 |
Sealant - per tooth |
24,480 |
5,833 |
$196K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,772 |
5,216 |
$172K |
| D1120 |
Prophylaxis - child |
32,372 |
30,585 |
$139K |
| D1206 |
Topical application of fluoride varnish |
41,381 |
39,199 |
$101K |
| D1330 |
|
43,387 |
41,166 |
$64K |
| D0272 |
Bitewings - two radiographic images |
27,556 |
26,213 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,036 |
1,892 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
10,106 |
4,626 |
$55K |
| D0145 |
Oral evaluation for a patient under three years of age |
825 |
793 |
$42K |
| D1510 |
|
120 |
101 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
1,868 |
1,754 |
$32K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,528 |
974 |
$11K |
| D0274 |
Bitewings - four radiographic images |
3,319 |
3,210 |
$10K |
| D2332 |
|
226 |
135 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
8,096 |
7,550 |
$10K |
| D9420 |
|
205 |
163 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,863 |
1,823 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
94 |
68 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,431 |
1,669 |
$3K |
| D1999 |
|
286 |
271 |
$2K |
| D9996 |
|
37 |
36 |
$2K |
| D3120 |
|
99 |
81 |
$923.91 |
| D2330 |
|
53 |
38 |
$395.92 |
| D2140 |
|
99 |
65 |
$381.68 |
| D0270 |
|
96 |
94 |
$82.37 |
| D0602 |
|
4,199 |
3,642 |
$0.00 |
| D0601 |
|
4,699 |
3,842 |
$0.00 |
| D0603 |
|
8,455 |
7,726 |
$0.00 |
| D9986 |
|
832 |
756 |
$0.00 |