| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
17,043 |
16,996 |
$1.13M |
| D1120 |
Prophylaxis - child |
22,703 |
22,632 |
$1.03M |
| D0230 |
Intraoral - periapical each additional radiographic image |
112,243 |
20,721 |
$461K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,529 |
22,457 |
$382K |
| D1310 |
|
7,190 |
7,161 |
$329K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,928 |
2,847 |
$325K |
| D1351 |
Sealant - per tooth |
8,693 |
1,997 |
$293K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,206 |
4,201 |
$286K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,626 |
6,163 |
$263K |
| D0274 |
Bitewings - four radiographic images |
8,041 |
8,020 |
$172K |
| D9993 |
|
2,224 |
2,220 |
$144K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,680 |
1,666 |
$113K |
| D8670 |
Periodic orthodontic treatment visit |
384 |
384 |
$112K |
| D0272 |
Bitewings - two radiographic images |
9,208 |
9,184 |
$109K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
851 |
563 |
$101K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,772 |
1,087 |
$100K |
| D9430 |
|
2,562 |
2,476 |
$82K |
| D0603 |
|
4,358 |
4,342 |
$65K |
| D2140 |
|
1,175 |
949 |
$63K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
624 |
392 |
$61K |
| D2160 |
|
665 |
553 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
699 |
434 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
3,509 |
3,432 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
654 |
444 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
808 |
808 |
$28K |
| D0350 |
|
2,667 |
1,557 |
$26K |
| D0602 |
|
1,602 |
1,598 |
$24K |
| D0330 |
Panoramic radiographic image |
755 |
755 |
$22K |
| D0601 |
|
465 |
465 |
$7K |
| D1354 |
|
16 |
16 |
$455.00 |