| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
19,804 |
19,760 |
$1.16M |
| D1120 |
Prophylaxis - child |
25,401 |
25,307 |
$1.04M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
9,630 |
4,742 |
$640K |
| D2140 |
|
11,577 |
5,307 |
$622K |
| D0230 |
Intraoral - periapical each additional radiographic image |
115,636 |
23,908 |
$470K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,604 |
11,113 |
$460K |
| D1351 |
Sealant - per tooth |
14,243 |
5,899 |
$414K |
| D1208 |
Topical application of fluoride, excluding varnish |
25,974 |
25,877 |
$393K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,179 |
1,424 |
$378K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,985 |
3,564 |
$321K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,115 |
4,108 |
$269K |
| D7111 |
|
4,566 |
2,551 |
$260K |
| D1310 |
|
5,223 |
5,198 |
$238K |
| D0350 |
|
18,452 |
9,504 |
$234K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,883 |
907 |
$186K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,287 |
2,281 |
$147K |
| D0272 |
Bitewings - two radiographic images |
11,507 |
11,474 |
$132K |
| D0274 |
Bitewings - four radiographic images |
6,060 |
6,041 |
$128K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,769 |
1,097 |
$100K |
| D0220 |
Intraoral - periapical first radiographic image |
7,392 |
7,223 |
$84K |
| D0330 |
Panoramic radiographic image |
2,695 |
2,691 |
$80K |
| D9430 |
|
1,904 |
1,857 |
$61K |
| D2330 |
|
795 |
467 |
$61K |
| D0603 |
|
3,919 |
3,901 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
887 |
886 |
$41K |
| D2160 |
|
382 |
284 |
$30K |
| D1510 |
|
220 |
190 |
$30K |
| D0602 |
|
351 |
347 |
$5K |
| D0601 |
|
348 |
348 |
$5K |
| D2332 |
|
35 |
25 |
$3K |
| D2331 |
|
18 |
12 |
$1K |