| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
50,880 |
50,431 |
$1.71M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
15,205 |
5,283 |
$1.40M |
| D2740 |
Crown - porcelain/ceramic |
3,384 |
2,399 |
$1.36M |
| D1120 |
Prophylaxis - child |
52,293 |
51,673 |
$1.33M |
| D1206 |
Topical application of fluoride varnish |
51,375 |
50,800 |
$913K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20,116 |
10,706 |
$894K |
| D1351 |
Sealant - per tooth |
50,354 |
11,041 |
$801K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,218 |
1,031 |
$524K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,658 |
5,287 |
$461K |
| D1110 |
Prophylaxis - adult |
10,943 |
10,835 |
$287K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14,015 |
13,874 |
$282K |
| D9420 |
|
807 |
778 |
$254K |
| D0210 |
Intraoral - complete series of radiographic images |
5,583 |
5,541 |
$228K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,350 |
3,261 |
$211K |
| D0140 |
Limited oral evaluation - problem focused |
11,431 |
11,133 |
$209K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,422 |
2,488 |
$209K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,878 |
2,447 |
$203K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,244 |
13,359 |
$165K |
| D0603 |
|
22,316 |
21,992 |
$161K |
| D0272 |
Bitewings - two radiographic images |
22,176 |
21,821 |
$138K |
| D0220 |
Intraoral - periapical first radiographic image |
25,239 |
24,127 |
$119K |
| D0274 |
Bitewings - four radiographic images |
6,020 |
5,876 |
$95K |
| D9920 |
|
6,931 |
6,731 |
$93K |
| D2954 |
|
886 |
638 |
$77K |
| D2950 |
|
1,411 |
1,072 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,521 |
16,923 |
$67K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,765 |
2,712 |
$53K |
| D0602 |
|
6,239 |
6,220 |
$43K |
| D3320 |
|
138 |
114 |
$43K |
| D0330 |
Panoramic radiographic image |
2,911 |
2,777 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,112 |
3,093 |
$38K |
| D2390 |
|
174 |
58 |
$20K |
| D1353 |
|
1,664 |
368 |
$14K |
| D2332 |
|
202 |
107 |
$12K |
| D1510 |
|
91 |
69 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
111 |
55 |
$9K |
| D2394 |
|
164 |
125 |
$6K |
| D0270 |
|
1,236 |
1,173 |
$5K |
| D0601 |
|
304 |
297 |
$3K |
| D2940 |
|
220 |
73 |
$2K |
| D7111 |
|
34 |
25 |
$2K |
| D4341 |
|
32 |
13 |
$2K |
| D0240 |
|
519 |
144 |
$1K |
| D2335 |
|
17 |
12 |
$825.00 |
| D2330 |
|
18 |
13 |
$782.50 |
| D9999 |
Unspecified adjunctive procedure, by report |
899 |
871 |
$709.75 |
| D0180 |
|
32 |
32 |
$600.00 |
| D9310 |
|
39 |
37 |
$393.75 |
| D4346 |
|
12 |
12 |
$385.00 |
| D9430 |
|
109 |
95 |
$0.00 |