| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
112,233 |
111,814 |
$6.12M |
| D1120 |
Prophylaxis - child |
144,611 |
143,844 |
$5.60M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
41,443 |
14,480 |
$4.86M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
32,193 |
12,964 |
$3.17M |
| D1310 |
|
47,277 |
47,060 |
$2.16M |
| D1208 |
Topical application of fluoride, excluding varnish |
144,373 |
143,606 |
$2.09M |
| D0230 |
Intraoral - periapical each additional radiographic image |
458,331 |
120,275 |
$1.89M |
| D9993 |
|
23,980 |
23,974 |
$1.55M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22,546 |
14,365 |
$1.50M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
21,063 |
20,987 |
$1.36M |
| D7140 |
Extraction, erupted tooth or exposed root |
15,960 |
9,652 |
$905K |
| D0274 |
Bitewings - four radiographic images |
38,884 |
38,725 |
$825K |
| D2140 |
|
14,808 |
9,865 |
$802K |
| D0272 |
Bitewings - two radiographic images |
60,920 |
60,636 |
$711K |
| D0145 |
Oral evaluation for a patient under three years of age |
11,515 |
11,472 |
$708K |
| D1351 |
Sealant - per tooth |
18,206 |
4,864 |
$611K |
| D0603 |
|
36,108 |
35,944 |
$537K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,038 |
12,948 |
$510K |
| D0350 |
|
31,769 |
19,478 |
$319K |
| D0220 |
Intraoral - periapical first radiographic image |
24,618 |
24,394 |
$289K |
| D2160 |
|
3,256 |
2,648 |
$257K |
| D2330 |
|
3,124 |
1,892 |
$241K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,137 |
2,034 |
$208K |
| D1510 |
|
1,155 |
993 |
$186K |
| D0602 |
|
9,584 |
9,534 |
$143K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,494 |
1,684 |
$135K |
| D9430 |
|
2,237 |
2,215 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
576 |
574 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
315 |
264 |
$25K |
| D2929 |
|
217 |
77 |
$22K |
| D2331 |
|
215 |
139 |
$17K |
| D2332 |
|
81 |
47 |
$6K |
| D2335 |
|
21 |
15 |
$2K |
| D1320 |
|
100 |
100 |
$1K |
| D0601 |
|
44 |
44 |
$660.00 |
| D1999 |
|
266 |
265 |
$184.00 |