| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
165,628 |
165,197 |
$9.06M |
| D1120 |
Prophylaxis - child |
200,689 |
200,119 |
$7.66M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
64,653 |
18,955 |
$7.45M |
| D1310 |
|
77,041 |
76,799 |
$3.53M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
34,277 |
12,625 |
$3.32M |
| D1206 |
Topical application of fluoride varnish |
200,182 |
199,618 |
$3.01M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
39,431 |
18,692 |
$2.55M |
| D9993 |
|
33,810 |
33,794 |
$2.18M |
| D1351 |
Sealant - per tooth |
75,272 |
19,798 |
$2.11M |
| D7111 |
|
24,692 |
12,452 |
$1.41M |
| D0145 |
Oral evaluation for a patient under three years of age |
21,059 |
21,008 |
$1.31M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17,314 |
17,264 |
$1.16M |
| D2140 |
|
18,309 |
11,286 |
$964K |
| D0603 |
|
55,732 |
55,571 |
$829K |
| D9248 |
|
24,463 |
24,341 |
$813K |
| D0272 |
Bitewings - two radiographic images |
68,099 |
67,905 |
$775K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27,463 |
27,186 |
$664K |
| D0230 |
Intraoral - periapical each additional radiographic image |
134,947 |
50,246 |
$567K |
| D0274 |
Bitewings - four radiographic images |
18,345 |
18,309 |
$361K |
| D0330 |
Panoramic radiographic image |
11,960 |
11,933 |
$345K |
| D0350 |
|
29,619 |
19,177 |
$314K |
| D0210 |
Intraoral - complete series of radiographic images |
5,399 |
5,398 |
$250K |
| D0220 |
Intraoral - periapical first radiographic image |
13,921 |
13,841 |
$158K |
| D0601 |
|
10,408 |
10,365 |
$155K |
| D0602 |
|
8,314 |
8,295 |
$124K |
| D9430 |
|
3,859 |
3,831 |
$119K |
| D2160 |
|
1,293 |
984 |
$99K |
| D2330 |
|
710 |
504 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
585 |
266 |
$29K |
| D1354 |
|
652 |
503 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
266 |
125 |
$17K |
| D1510 |
|
67 |
57 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
203 |
93 |
$7K |
| D0270 |
|
767 |
766 |
$4K |
| D2931 |
|
19 |
12 |
$2K |
| D9110 |
|
12 |
12 |
$756.00 |