| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
26,599 |
26,490 |
$1.52M |
| D1120 |
Prophylaxis - child |
35,608 |
35,443 |
$1.41M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16,551 |
8,058 |
$1.10M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,361 |
4,077 |
$854K |
| D0230 |
Intraoral - periapical each additional radiographic image |
189,233 |
40,310 |
$806K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,763 |
4,158 |
$760K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16,606 |
15,969 |
$654K |
| D1310 |
|
12,712 |
12,649 |
$580K |
| D1208 |
Topical application of fluoride, excluding varnish |
35,086 |
34,919 |
$546K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,077 |
4,945 |
$454K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,055 |
5,399 |
$430K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,675 |
6,647 |
$418K |
| D1351 |
Sealant - per tooth |
14,301 |
5,786 |
$405K |
| D9993 |
|
5,412 |
5,411 |
$348K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,687 |
2,705 |
$305K |
| D2140 |
|
5,006 |
3,004 |
$270K |
| D0220 |
Intraoral - periapical first radiographic image |
22,442 |
21,534 |
$262K |
| D2330 |
|
3,216 |
2,025 |
$246K |
| D2160 |
|
2,851 |
2,118 |
$223K |
| D0350 |
|
17,307 |
10,769 |
$193K |
| D0274 |
Bitewings - four radiographic images |
8,791 |
8,745 |
$185K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,032 |
3,020 |
$183K |
| D0272 |
Bitewings - two radiographic images |
14,497 |
14,437 |
$170K |
| D0603 |
|
10,617 |
10,565 |
$158K |
| D1510 |
|
911 |
804 |
$116K |
| D9430 |
|
1,357 |
1,329 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
487 |
339 |
$38K |
| D0602 |
|
1,289 |
1,285 |
$19K |
| D2331 |
|
73 |
55 |
$6K |
| D1320 |
|
548 |
548 |
$5K |
| D0601 |
|
66 |
66 |
$971.25 |
| D9994 |
|
12 |
12 |
$277.92 |
| D1354 |
|
31 |
15 |
$192.00 |
| D1206 |
Topical application of fluoride varnish |
28 |
28 |
$55.50 |
| D3120 |
|
23 |
15 |
$0.00 |