| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
45,116 |
44,916 |
$2.62M |
| D1120 |
Prophylaxis - child |
53,575 |
53,251 |
$2.14M |
| D0230 |
Intraoral - periapical each additional radiographic image |
232,499 |
55,330 |
$956K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
21,769 |
20,891 |
$844K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,172 |
7,503 |
$804K |
| D1208 |
Topical application of fluoride, excluding varnish |
53,499 |
53,169 |
$736K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13,563 |
7,584 |
$720K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,400 |
5,717 |
$530K |
| D1310 |
|
11,137 |
11,084 |
$506K |
| D0272 |
Bitewings - two radiographic images |
37,710 |
37,478 |
$425K |
| D1351 |
Sealant - per tooth |
14,793 |
5,062 |
$405K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,191 |
2,105 |
$369K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,415 |
5,410 |
$338K |
| D9993 |
|
4,400 |
4,388 |
$282K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,795 |
1,061 |
$176K |
| D0274 |
Bitewings - four radiographic images |
8,181 |
8,140 |
$173K |
| D8670 |
Periodic orthodontic treatment visit |
591 |
591 |
$167K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,196 |
1,167 |
$145K |
| D9430 |
|
3,749 |
3,644 |
$118K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,695 |
1,691 |
$107K |
| D0603 |
|
7,203 |
7,135 |
$106K |
| D0220 |
Intraoral - periapical first radiographic image |
5,931 |
5,811 |
$69K |
| D2330 |
|
717 |
440 |
$54K |
| D0350 |
|
5,333 |
2,641 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,020 |
1,019 |
$36K |
| D2140 |
|
627 |
362 |
$33K |
| D0330 |
Panoramic radiographic image |
687 |
686 |
$20K |
| D0602 |
|
1,338 |
1,334 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
225 |
188 |
$18K |
| D1510 |
|
51 |
49 |
$6K |
| D0601 |
|
351 |
351 |
$5K |