| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
73,852 |
72,398 |
$1.92M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,283 |
6,708 |
$1.64M |
| D1120 |
Prophylaxis - child |
56,397 |
54,964 |
$1.53M |
| D1351 |
Sealant - per tooth |
53,169 |
14,866 |
$1.47M |
| D1206 |
Topical application of fluoride varnish |
69,766 |
67,927 |
$1.14M |
| D1110 |
Prophylaxis - adult |
28,295 |
27,680 |
$1.08M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
22,075 |
20,469 |
$984K |
| D2140 |
|
10,476 |
7,036 |
$768K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,674 |
4,483 |
$629K |
| D0330 |
Panoramic radiographic image |
11,468 |
11,137 |
$586K |
| D0220 |
Intraoral - periapical first radiographic image |
37,161 |
36,308 |
$559K |
| D0274 |
Bitewings - four radiographic images |
15,908 |
15,520 |
$503K |
| D0272 |
Bitewings - two radiographic images |
23,177 |
22,718 |
$424K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,900 |
6,596 |
$299K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,419 |
14,194 |
$226K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,456 |
2,051 |
$221K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,151 |
1,589 |
$176K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,272 |
11,515 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,062 |
697 |
$115K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,106 |
2,757 |
$101K |
| D0140 |
Limited oral evaluation - problem focused |
2,670 |
2,583 |
$100K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
986 |
650 |
$79K |
| D2160 |
|
571 |
467 |
$63K |
| D7111 |
|
638 |
454 |
$33K |
| D2331 |
|
85 |
55 |
$7K |
| D2330 |
|
104 |
77 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
26 |
$4K |
| D0350 |
|
13,404 |
13,044 |
$3K |
| D2950 |
|
16 |
13 |
$2K |
| D1354 |
|
41 |
15 |
$308.00 |
| D0270 |
|
14 |
14 |
$47.48 |
| D1999 |
|
162 |
161 |
$0.00 |