| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
31,456 |
31,347 |
$1.72M |
| D1120 |
Prophylaxis - child |
34,937 |
34,787 |
$1.35M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13,597 |
6,206 |
$908K |
| D0230 |
Intraoral - periapical each additional radiographic image |
175,330 |
32,728 |
$697K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,025 |
2,070 |
$587K |
| D1351 |
Sealant - per tooth |
19,489 |
7,002 |
$542K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,042 |
2,087 |
$498K |
| D1310 |
|
8,571 |
8,522 |
$393K |
| D2140 |
|
6,790 |
3,948 |
$369K |
| D1208 |
Topical application of fluoride, excluding varnish |
27,868 |
27,765 |
$301K |
| D9993 |
|
4,543 |
4,541 |
$288K |
| D7111 |
|
4,745 |
2,973 |
$271K |
| D0272 |
Bitewings - two radiographic images |
22,753 |
22,657 |
$267K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,698 |
1,561 |
$247K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,576 |
3,561 |
$229K |
| D2330 |
|
2,843 |
1,266 |
$218K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,294 |
1,437 |
$179K |
| D0350 |
|
18,715 |
8,231 |
$178K |
| D1206 |
Topical application of fluoride varnish |
7,340 |
7,287 |
$171K |
| D0603 |
|
7,976 |
7,926 |
$119K |
| D0220 |
Intraoral - periapical first radiographic image |
9,910 |
9,741 |
$117K |
| D9430 |
|
3,615 |
3,493 |
$115K |
| D2160 |
|
1,420 |
1,015 |
$112K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
227 |
166 |
$109K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,623 |
1,613 |
$97K |
| D0274 |
Bitewings - four radiographic images |
2,946 |
2,943 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
870 |
583 |
$49K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
599 |
417 |
$48K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
93 |
69 |
$44K |
| D4341 |
|
576 |
210 |
$40K |
| D0330 |
Panoramic radiographic image |
913 |
912 |
$27K |
| D4910 |
|
290 |
290 |
$22K |
| D9222 |
|
166 |
166 |
$20K |
| D1510 |
|
120 |
112 |
$14K |
| D9610 |
|
214 |
166 |
$14K |
| D0602 |
|
409 |
409 |
$6K |
| D1110 |
Prophylaxis - adult |
55 |
55 |
$5K |
| D4342 |
|
99 |
37 |
$4K |
| D2331 |
|
25 |
12 |
$2K |
| D2954 |
|
19 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
47 |
42 |
$2K |