| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
88,502 |
88,213 |
$4.78M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
37,432 |
9,961 |
$4.26M |
| D1120 |
Prophylaxis - child |
107,404 |
107,008 |
$4.00M |
| D1310 |
|
40,064 |
39,904 |
$1.84M |
| D1206 |
Topical application of fluoride varnish |
105,869 |
105,479 |
$1.54M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
15,549 |
5,645 |
$1.49M |
| D9993 |
|
18,316 |
18,311 |
$1.18M |
| D1351 |
Sealant - per tooth |
40,393 |
10,709 |
$1.09M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14,432 |
6,587 |
$911K |
| D7111 |
|
13,479 |
6,520 |
$768K |
| D0145 |
Oral evaluation for a patient under three years of age |
9,550 |
9,529 |
$579K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,332 |
8,291 |
$538K |
| D9248 |
|
13,691 |
13,570 |
$455K |
| D0272 |
Bitewings - two radiographic images |
38,684 |
38,542 |
$433K |
| D0603 |
|
27,589 |
27,479 |
$409K |
| D2140 |
|
6,998 |
4,072 |
$361K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,387 |
14,192 |
$359K |
| D0230 |
Intraoral - periapical each additional radiographic image |
61,988 |
26,590 |
$256K |
| D0330 |
Panoramic radiographic image |
6,076 |
6,063 |
$172K |
| D0350 |
|
15,571 |
9,583 |
$167K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,062 |
1,456 |
$155K |
| D0274 |
Bitewings - four radiographic images |
6,657 |
6,633 |
$125K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,821 |
933 |
$111K |
| D0210 |
Intraoral - complete series of radiographic images |
2,453 |
2,450 |
$110K |
| D0601 |
|
6,249 |
6,225 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
6,971 |
6,927 |
$78K |
| D0602 |
|
3,596 |
3,580 |
$53K |
| D9430 |
|
1,522 |
1,515 |
$47K |
| D2160 |
|
123 |
69 |
$9K |
| D2330 |
|
94 |
62 |
$6K |
| D1510 |
|
14 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
16 |
$674.60 |
| D0270 |
|
135 |
135 |
$642.50 |