| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
29,366 |
27,598 |
$4.12M |
| D1120 |
Prophylaxis - child |
53,587 |
53,273 |
$2.12M |
| D1310 |
|
33,670 |
31,570 |
$1.89M |
| D0120 |
Periodic oral evaluation - established patient |
41,732 |
41,609 |
$1.62M |
| D1351 |
Sealant - per tooth |
29,321 |
7,311 |
$1.02M |
| D1206 |
Topical application of fluoride varnish |
42,759 |
42,441 |
$939K |
| D0230 |
Intraoral - periapical each additional radiographic image |
183,260 |
47,029 |
$745K |
| D0274 |
Bitewings - four radiographic images |
29,424 |
29,344 |
$657K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
8,538 |
6,934 |
$570K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,400 |
9,273 |
$482K |
| D1208 |
Topical application of fluoride, excluding varnish |
30,445 |
30,350 |
$302K |
| D1320 |
|
13,018 |
12,433 |
$209K |
| D2140 |
|
3,615 |
3,178 |
$198K |
| D9430 |
|
4,371 |
4,244 |
$190K |
| D9952 |
|
314 |
314 |
$177K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,622 |
1,789 |
$173K |
| D0272 |
Bitewings - two radiographic images |
14,031 |
13,944 |
$171K |
| D9950 |
|
703 |
703 |
$164K |
| D0330 |
Panoramic radiographic image |
4,840 |
4,817 |
$153K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,051 |
3,026 |
$150K |
| D0603 |
|
7,694 |
7,597 |
$147K |
| D2160 |
|
1,646 |
1,442 |
$128K |
| D1354 |
|
3,307 |
892 |
$119K |
| D9910 |
|
3,241 |
3,044 |
$105K |
| D0350 |
|
10,962 |
6,844 |
$101K |
| D8220 |
|
241 |
239 |
$77K |
| D0601 |
|
3,284 |
3,255 |
$63K |
| D1110 |
Prophylaxis - adult |
760 |
759 |
$59K |
| D8660 |
|
886 |
885 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
3,968 |
3,914 |
$49K |
| D0160 |
|
370 |
370 |
$47K |
| D8210 |
|
137 |
137 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
914 |
914 |
$41K |
| D4355 |
|
344 |
344 |
$40K |
| D8704 |
|
150 |
150 |
$39K |
| D8703 |
|
150 |
150 |
$39K |
| D0340 |
|
634 |
629 |
$38K |
| D0470 |
|
381 |
381 |
$37K |
| D7240 |
Removal of impacted tooth - completely bony |
72 |
42 |
$32K |
| D7230 |
|
71 |
35 |
$26K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
145 |
119 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
116 |
98 |
$12K |
| D2330 |
|
103 |
67 |
$8K |
| D0602 |
|
387 |
381 |
$7K |
| D0270 |
|
844 |
814 |
$4K |