| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
34,564 |
34,394 |
$1.53M |
| D0120 |
Periodic oral evaluation - established patient |
22,792 |
22,667 |
$1.47M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,140 |
3,396 |
$1.21M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15,807 |
7,440 |
$1.06M |
| D1310 |
|
17,225 |
17,152 |
$784K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,816 |
2,684 |
$775K |
| D7140 |
Extraction, erupted tooth or exposed root |
11,240 |
5,906 |
$643K |
| D1208 |
Topical application of fluoride, excluding varnish |
35,819 |
35,648 |
$633K |
| D2140 |
|
10,915 |
5,908 |
$593K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,765 |
8,747 |
$591K |
| D0230 |
Intraoral - periapical each additional radiographic image |
127,154 |
30,654 |
$590K |
| D1351 |
Sealant - per tooth |
19,753 |
7,140 |
$581K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,132 |
13,017 |
$522K |
| D9993 |
|
6,326 |
6,312 |
$403K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,966 |
3,947 |
$264K |
| D0220 |
Intraoral - periapical first radiographic image |
19,720 |
19,470 |
$236K |
| D0603 |
|
15,856 |
15,786 |
$235K |
| D2330 |
|
2,912 |
1,749 |
$224K |
| D0350 |
|
19,156 |
10,318 |
$224K |
| D2160 |
|
2,561 |
1,677 |
$204K |
| D0210 |
Intraoral - complete series of radiographic images |
3,143 |
3,136 |
$151K |
| D0272 |
Bitewings - two radiographic images |
11,422 |
11,385 |
$137K |
| D9430 |
|
2,804 |
2,697 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,127 |
759 |
$76K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,088 |
673 |
$59K |
| D0274 |
Bitewings - four radiographic images |
2,664 |
2,630 |
$57K |
| D1110 |
Prophylaxis - adult |
475 |
475 |
$42K |
| D1510 |
|
183 |
157 |
$24K |
| D2331 |
|
234 |
166 |
$19K |
| D4341 |
|
198 |
50 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
160 |
131 |
$13K |
| D2332 |
|
121 |
81 |
$9K |
| D0602 |
|
482 |
480 |
$7K |
| D2932 |
|
57 |
27 |
$6K |
| D4910 |
|
12 |
12 |
$924.00 |
| D0601 |
|
16 |
16 |
$225.00 |