| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12,692 |
12,640 |
$692K |
| D1120 |
Prophylaxis - child |
14,185 |
14,128 |
$548K |
| D0230 |
Intraoral - periapical each additional radiographic image |
78,559 |
15,005 |
$328K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,728 |
1,934 |
$251K |
| D1351 |
Sealant - per tooth |
8,919 |
2,489 |
$246K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,272 |
2,085 |
$232K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,631 |
15,557 |
$218K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,748 |
2,739 |
$179K |
| D0272 |
Bitewings - two radiographic images |
11,804 |
11,759 |
$139K |
| D1110 |
Prophylaxis - adult |
1,593 |
1,588 |
$134K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,778 |
675 |
$118K |
| D1310 |
|
2,350 |
2,337 |
$107K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,555 |
947 |
$89K |
| D9430 |
|
2,613 |
2,543 |
$82K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
647 |
273 |
$73K |
| D2140 |
|
1,304 |
433 |
$70K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
693 |
271 |
$68K |
| D9993 |
|
940 |
940 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
1,260 |
1,257 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
4,205 |
4,125 |
$50K |
| D2330 |
|
293 |
111 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
281 |
193 |
$22K |
| D0603 |
|
1,251 |
1,238 |
$19K |
| D4910 |
|
196 |
180 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
289 |
289 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
283 |
274 |
$11K |
| D4341 |
|
184 |
49 |
$11K |
| D1320 |
|
506 |
506 |
$9K |
| D1206 |
Topical application of fluoride varnish |
447 |
447 |
$8K |
| D0601 |
|
487 |
487 |
$7K |
| D2160 |
|
82 |
56 |
$6K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
13 |
12 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
101 |
101 |
$4K |
| D0350 |
|
203 |
96 |
$2K |
| D1354 |
|
14 |
14 |
$490.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$33.60 |
| D0999 |
Unspecified diagnostic procedure, by report |
12 |
12 |
$0.00 |