| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
18,952 |
18,898 |
$1.07M |
| D1120 |
Prophylaxis - child |
23,509 |
23,433 |
$940K |
| D0230 |
Intraoral - periapical each additional radiographic image |
117,156 |
24,589 |
$502K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,493 |
3,236 |
$427K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,099 |
23,025 |
$344K |
| D1310 |
|
7,435 |
7,400 |
$340K |
| D1351 |
Sealant - per tooth |
9,576 |
3,358 |
$266K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,904 |
5,704 |
$232K |
| D9993 |
|
2,956 |
2,952 |
$190K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,335 |
2,057 |
$188K |
| D0274 |
Bitewings - four radiographic images |
8,413 |
8,391 |
$177K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,406 |
2,404 |
$152K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,110 |
1,266 |
$138K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,112 |
580 |
$128K |
| D0220 |
Intraoral - periapical first radiographic image |
10,672 |
10,373 |
$124K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,138 |
565 |
$112K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,991 |
1,290 |
$106K |
| D0272 |
Bitewings - two radiographic images |
7,515 |
7,502 |
$87K |
| D0350 |
|
7,232 |
4,461 |
$75K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,214 |
1,212 |
$74K |
| D2140 |
|
1,344 |
820 |
$72K |
| D0603 |
|
4,741 |
4,718 |
$70K |
| D2160 |
|
377 |
249 |
$29K |
| D0602 |
|
1,411 |
1,404 |
$21K |
| D9430 |
|
359 |
354 |
$11K |
| D2330 |
|
146 |
94 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
87 |
63 |
$7K |
| D1320 |
|
426 |
426 |
$4K |
| D1206 |
Topical application of fluoride varnish |
250 |
249 |
$4K |
| D0601 |
|
241 |
240 |
$4K |
| D1510 |
|
12 |
12 |
$3K |