| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
27,548 |
27,515 |
$1.52M |
| D1120 |
Prophylaxis - child |
28,858 |
28,827 |
$1.09M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
10,888 |
6,103 |
$725K |
| D0230 |
Intraoral - periapical each additional radiographic image |
151,869 |
28,212 |
$618K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,017 |
7,842 |
$316K |
| D0274 |
Bitewings - four radiographic images |
12,276 |
12,264 |
$258K |
| D1351 |
Sealant - per tooth |
8,888 |
2,863 |
$251K |
| D0210 |
Intraoral - complete series of radiographic images |
4,760 |
4,754 |
$220K |
| D1206 |
Topical application of fluoride varnish |
16,893 |
16,885 |
$218K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,355 |
3,353 |
$208K |
| D2140 |
|
3,558 |
2,332 |
$193K |
| D1310 |
|
4,210 |
4,204 |
$191K |
| D9993 |
|
2,691 |
2,690 |
$173K |
| D1110 |
Prophylaxis - adult |
1,936 |
1,930 |
$167K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,282 |
14,254 |
$166K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,693 |
1,794 |
$145K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,205 |
1,525 |
$125K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,133 |
393 |
$112K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
928 |
414 |
$106K |
| D0350 |
|
8,948 |
5,699 |
$96K |
| D0272 |
Bitewings - two radiographic images |
7,964 |
7,953 |
$93K |
| D2330 |
|
1,158 |
745 |
$88K |
| D0220 |
Intraoral - periapical first radiographic image |
6,153 |
6,066 |
$72K |
| D2160 |
|
834 |
604 |
$66K |
| D9430 |
|
1,844 |
1,805 |
$58K |
| D0603 |
|
2,350 |
2,342 |
$35K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
60 |
53 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
717 |
717 |
$25K |
| D8670 |
Periodic orthodontic treatment visit |
38 |
38 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
152 |
116 |
$10K |
| D0330 |
Panoramic radiographic image |
147 |
147 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
31 |
25 |
$4K |
| D1320 |
|
233 |
233 |
$3K |
| D2932 |
|
21 |
12 |
$2K |
| D2332 |
|
18 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$1K |
| D4910 |
|
13 |
13 |
$1K |
| D0602 |
|
39 |
39 |
$585.00 |
| D0601 |
|
31 |
31 |
$465.00 |
| D0270 |
|
76 |
76 |
$380.00 |