| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
38,355 |
38,112 |
$2.22M |
| D1120 |
Prophylaxis - child |
42,781 |
42,565 |
$1.72M |
| D2751 |
Crown - porcelain fused to predominantly base metal |
3,342 |
2,284 |
$1.59M |
| D0230 |
Intraoral - periapical each additional radiographic image |
250,795 |
48,909 |
$1.05M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,950 |
2,697 |
$823K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,823 |
2,953 |
$771K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,999 |
11,962 |
$770K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,125 |
4,897 |
$743K |
| D1208 |
Topical application of fluoride, excluding varnish |
47,394 |
47,158 |
$698K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,267 |
1,067 |
$585K |
| D7111 |
|
9,718 |
4,805 |
$556K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
7,774 |
3,360 |
$512K |
| D1310 |
|
11,106 |
11,075 |
$496K |
| D0272 |
Bitewings - two radiographic images |
39,700 |
39,528 |
$468K |
| D8670 |
Periodic orthodontic treatment visit |
1,585 |
1,583 |
$443K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,708 |
1,866 |
$433K |
| D1351 |
Sealant - per tooth |
11,122 |
3,024 |
$369K |
| D9993 |
|
4,891 |
4,882 |
$300K |
| D7240 |
Removal of impacted tooth - completely bony |
1,277 |
550 |
$295K |
| D2954 |
|
2,778 |
1,961 |
$291K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,220 |
7,139 |
$284K |
| D7230 |
|
1,255 |
632 |
$237K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,740 |
1,558 |
$218K |
| D4341 |
|
2,497 |
692 |
$167K |
| D4910 |
|
1,797 |
1,790 |
$148K |
| D1110 |
Prophylaxis - adult |
1,717 |
1,706 |
$147K |
| D0603 |
|
8,467 |
8,446 |
$124K |
| D0140 |
Limited oral evaluation - problem focused |
3,332 |
3,314 |
$111K |
| D0340 |
|
2,141 |
2,133 |
$106K |
| D0330 |
Panoramic radiographic image |
3,313 |
3,296 |
$96K |
| D0210 |
Intraoral - complete series of radiographic images |
2,004 |
1,992 |
$96K |
| D2160 |
|
1,185 |
713 |
$94K |
| D0220 |
Intraoral - periapical first radiographic image |
7,530 |
7,464 |
$90K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,149 |
1,128 |
$77K |
| D3320 |
|
176 |
147 |
$64K |
| D9430 |
|
1,253 |
1,237 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
648 |
387 |
$35K |
| D0350 |
|
1,699 |
893 |
$16K |
| D0602 |
|
799 |
796 |
$12K |
| D4342 |
|
251 |
83 |
$11K |
| D2933 |
|
103 |
40 |
$10K |
| D5850 |
|
139 |
138 |
$10K |
| D2330 |
|
114 |
64 |
$9K |
| D1510 |
|
62 |
52 |
$9K |
| D0601 |
|
487 |
485 |
$7K |
| D5750 |
|
29 |
29 |
$6K |
| D2140 |
|
95 |
62 |
$5K |
| D5851 |
|
44 |
44 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
20 |
20 |
$1K |