| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
31,985 |
31,323 |
$875K |
| D0120 |
Periodic oral evaluation - established patient |
37,758 |
36,961 |
$722K |
| D1206 |
Topical application of fluoride varnish |
30,848 |
30,308 |
$513K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,758 |
1,992 |
$509K |
| D1110 |
Prophylaxis - adult |
12,999 |
12,703 |
$507K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
7,604 |
5,755 |
$456K |
| D1208 |
Topical application of fluoride, excluding varnish |
28,427 |
27,674 |
$407K |
| D2140 |
|
6,119 |
4,624 |
$295K |
| D1351 |
Sealant - per tooth |
12,491 |
3,137 |
$280K |
| D0274 |
Bitewings - four radiographic images |
11,211 |
10,926 |
$269K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,113 |
9,841 |
$254K |
| D0272 |
Bitewings - two radiographic images |
14,146 |
13,849 |
$247K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,418 |
1,842 |
$174K |
| D0220 |
Intraoral - periapical first radiographic image |
11,149 |
10,562 |
$111K |
| D0190 |
|
8,160 |
8,043 |
$101K |
| D0330 |
Panoramic radiographic image |
2,719 |
2,624 |
$99K |
| D4910 |
|
1,547 |
1,513 |
$90K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,155 |
4,166 |
$85K |
| D0140 |
Limited oral evaluation - problem focused |
2,897 |
2,766 |
$74K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,624 |
3,201 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,081 |
796 |
$65K |
| D4341 |
|
928 |
423 |
$64K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,727 |
1,693 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
393 |
303 |
$34K |
| D1353 |
|
1,315 |
350 |
$28K |
| D9310 |
|
544 |
540 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
312 |
303 |
$15K |
| D4346 |
|
132 |
128 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
78 |
39 |
$5K |
| D2160 |
|
51 |
40 |
$4K |
| D2950 |
|
40 |
28 |
$4K |
| D0240 |
|
340 |
209 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
31 |
14 |
$2K |
| D1354 |
|
80 |
24 |
$294.90 |
| D0603 |
|
56 |
53 |
$175.00 |
| D0270 |
|
14 |
13 |
$114.90 |
| D1999 |
|
8,279 |
7,637 |
$16.00 |
| D1330 |
|
84 |
83 |
$0.00 |
| 00190 |
|
88 |
87 |
$0.00 |