| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
37,254 |
37,163 |
$2.02M |
| D1120 |
Prophylaxis - child |
39,895 |
39,796 |
$1.53M |
| D0230 |
Intraoral - periapical each additional radiographic image |
223,775 |
38,431 |
$886K |
| D0274 |
Bitewings - four radiographic images |
23,590 |
23,524 |
$496K |
| D1208 |
Topical application of fluoride, excluding varnish |
33,886 |
33,807 |
$364K |
| D1310 |
|
6,098 |
6,083 |
$280K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,730 |
2,614 |
$240K |
| D9993 |
|
2,987 |
2,987 |
$194K |
| D0272 |
Bitewings - two radiographic images |
13,081 |
13,058 |
$152K |
| D1351 |
Sealant - per tooth |
5,095 |
1,416 |
$139K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,177 |
2,175 |
$136K |
| D1352 |
|
4,408 |
1,165 |
$129K |
| D1206 |
Topical application of fluoride varnish |
5,820 |
5,802 |
$120K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,989 |
2,885 |
$116K |
| D9110 |
|
1,150 |
889 |
$71K |
| D0603 |
|
4,445 |
4,431 |
$66K |
| D9430 |
|
1,801 |
1,779 |
$56K |
| D0350 |
|
4,991 |
3,168 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
3,361 |
3,335 |
$39K |
| D2160 |
|
478 |
397 |
$37K |
| D0145 |
Oral evaluation for a patient under three years of age |
545 |
544 |
$28K |
| D0601 |
|
1,596 |
1,593 |
$24K |
| D2140 |
|
378 |
326 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
78 |
74 |
$7K |