| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
58,710 |
58,179 |
$3.21M |
| D1120 |
Prophylaxis - child |
75,947 |
75,302 |
$2.95M |
| D1310 |
|
31,599 |
31,004 |
$1.44M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,005 |
6,169 |
$1.39M |
| D9993 |
|
17,742 |
17,227 |
$1.14M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
10,290 |
5,388 |
$1.00M |
| D0230 |
Intraoral - periapical each additional radiographic image |
224,282 |
58,502 |
$929K |
| D1208 |
Topical application of fluoride, excluding varnish |
48,170 |
48,068 |
$799K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
10,668 |
6,747 |
$705K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,512 |
10,505 |
$678K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,101 |
5,515 |
$511K |
| D0145 |
Oral evaluation for a patient under three years of age |
7,039 |
7,019 |
$430K |
| D1351 |
Sealant - per tooth |
11,148 |
3,447 |
$389K |
| D2140 |
|
7,215 |
4,812 |
$388K |
| D0274 |
Bitewings - four radiographic images |
16,091 |
16,074 |
$339K |
| D0603 |
|
22,433 |
21,948 |
$331K |
| D1206 |
Topical application of fluoride varnish |
27,080 |
26,540 |
$321K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,185 |
8,065 |
$321K |
| D0272 |
Bitewings - two radiographic images |
27,422 |
27,355 |
$319K |
| D0220 |
Intraoral - periapical first radiographic image |
17,913 |
17,666 |
$207K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,228 |
1,316 |
$145K |
| D0350 |
|
12,875 |
8,339 |
$130K |
| D1510 |
|
850 |
737 |
$115K |
| D0602 |
|
7,673 |
7,585 |
$114K |
| D2160 |
|
1,204 |
1,037 |
$95K |
| D2330 |
|
892 |
599 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,202 |
864 |
$63K |
| D9430 |
|
1,307 |
1,302 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
101 |
85 |
$8K |
| D0601 |
|
420 |
416 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
48 |
48 |
$2K |
| D2331 |
|
19 |
13 |
$2K |
| D1354 |
|
17 |
12 |
$595.00 |
| D1999 |
|
40 |
40 |
$126.50 |