| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
39,906 |
39,772 |
$1.67M |
| D0120 |
Periodic oral evaluation - established patient |
27,047 |
26,964 |
$1.65M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,076 |
4,396 |
$1.43M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18,747 |
9,525 |
$1.26M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
10,562 |
3,757 |
$1.04M |
| D1351 |
Sealant - per tooth |
32,583 |
10,855 |
$977K |
| D0230 |
Intraoral - periapical each additional radiographic image |
204,917 |
39,222 |
$899K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
18,168 |
17,953 |
$719K |
| D1310 |
|
15,393 |
15,328 |
$697K |
| D1208 |
Topical application of fluoride, excluding varnish |
40,203 |
40,055 |
$655K |
| D2140 |
|
11,531 |
7,414 |
$628K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,574 |
9,542 |
$618K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,704 |
4,220 |
$442K |
| D2330 |
|
4,690 |
2,696 |
$364K |
| D9993 |
|
5,735 |
5,732 |
$362K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,313 |
4,305 |
$275K |
| D2160 |
|
3,335 |
2,249 |
$266K |
| D7111 |
|
4,304 |
2,429 |
$246K |
| D0274 |
Bitewings - four radiographic images |
10,863 |
10,835 |
$233K |
| D0272 |
Bitewings - two radiographic images |
17,065 |
16,989 |
$201K |
| D0350 |
|
16,939 |
10,452 |
$190K |
| D0603 |
|
11,713 |
11,664 |
$173K |
| D0220 |
Intraoral - periapical first radiographic image |
8,163 |
8,074 |
$95K |
| D0601 |
|
1,982 |
1,980 |
$29K |
| D1320 |
|
2,891 |
2,889 |
$23K |
| D0602 |
|
1,016 |
1,009 |
$15K |
| D9430 |
|
248 |
248 |
$8K |
| D1510 |
|
46 |
41 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
115 |
115 |
$6K |
| D9920 |
|
12 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
14 |
$1K |