| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
82,205 |
79,928 |
$2.06M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13,513 |
3,877 |
$1.88M |
| D1206 |
Topical application of fluoride varnish |
87,989 |
84,690 |
$1.50M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22,380 |
12,388 |
$1.39M |
| D1120 |
Prophylaxis - child |
61,596 |
59,518 |
$1.38M |
| D1110 |
Prophylaxis - adult |
30,644 |
29,649 |
$1.12M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15,830 |
7,919 |
$1.05M |
| D1351 |
Sealant - per tooth |
48,971 |
12,883 |
$1.05M |
| D2140 |
|
18,499 |
10,704 |
$941K |
| D0330 |
Panoramic radiographic image |
23,280 |
22,136 |
$751K |
| D2390 |
|
3,629 |
1,058 |
$703K |
| D0220 |
Intraoral - periapical first radiographic image |
86,767 |
80,888 |
$683K |
| D7140 |
Extraction, erupted tooth or exposed root |
14,146 |
6,666 |
$678K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17,284 |
15,936 |
$606K |
| D2160 |
|
6,874 |
4,642 |
$496K |
| D7240 |
Removal of impacted tooth - completely bony |
3,469 |
1,358 |
$457K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,100 |
2,113 |
$454K |
| D0274 |
Bitewings - four radiographic images |
34,585 |
32,988 |
$436K |
| D0140 |
Limited oral evaluation - problem focused |
20,353 |
18,861 |
$428K |
| D9999 |
Unspecified adjunctive procedure, by report |
17,397 |
16,701 |
$371K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,608 |
3,861 |
$363K |
| D0272 |
Bitewings - two radiographic images |
36,042 |
34,978 |
$348K |
| D2331 |
|
4,650 |
2,782 |
$322K |
| D7230 |
|
2,308 |
1,204 |
$257K |
| D0230 |
Intraoral - periapical each additional radiographic image |
101,669 |
75,642 |
$225K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,877 |
8,885 |
$214K |
| D1999 |
|
11,796 |
10,199 |
$148K |
| D2330 |
|
2,462 |
1,475 |
$134K |
| D2332 |
|
1,342 |
804 |
$126K |
| D9920 |
|
3,760 |
3,588 |
$77K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
886 |
513 |
$73K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
979 |
724 |
$69K |
| D7311 |
|
140 |
87 |
$25K |
| D2335 |
|
150 |
107 |
$16K |
| D7250 |
|
206 |
80 |
$16K |
| D7310 |
|
72 |
30 |
$13K |
| D5110 |
|
14 |
13 |
$10K |
| D7220 |
|
93 |
61 |
$6K |
| D1510 |
|
86 |
51 |
$6K |
| D9992 |
|
570 |
433 |
$6K |
| D0270 |
|
694 |
664 |
$3K |
| D2161 |
|
35 |
29 |
$2K |
| D9930 |
|
39 |
36 |
$2K |
| D1354 |
|
25 |
13 |
$106.80 |
| D1330 |
|
74 |
74 |
$0.00 |