| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
65,047 |
63,646 |
$1.69M |
| D1120 |
Prophylaxis - child |
54,043 |
52,657 |
$1.46M |
| D2140 |
|
20,437 |
8,070 |
$1.34M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,920 |
5,022 |
$1.15M |
| D1206 |
Topical application of fluoride varnish |
65,105 |
63,377 |
$1.06M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,325 |
6,310 |
$896K |
| D1110 |
Prophylaxis - adult |
22,402 |
21,870 |
$856K |
| D1351 |
Sealant - per tooth |
25,429 |
7,476 |
$685K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,645 |
14,040 |
$647K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,674 |
4,498 |
$532K |
| D0220 |
Intraoral - periapical first radiographic image |
34,369 |
33,479 |
$517K |
| D0330 |
Panoramic radiographic image |
10,605 |
10,340 |
$500K |
| D0272 |
Bitewings - two radiographic images |
24,242 |
23,684 |
$428K |
| D0274 |
Bitewings - four radiographic images |
12,779 |
12,482 |
$401K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,578 |
2,817 |
$378K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,436 |
7,271 |
$331K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,353 |
2,671 |
$270K |
| D9243 |
|
2,424 |
516 |
$260K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,141 |
10,932 |
$172K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,216 |
10,383 |
$135K |
| D7230 |
|
800 |
256 |
$128K |
| D0140 |
Limited oral evaluation - problem focused |
2,568 |
2,477 |
$95K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,449 |
2,341 |
$85K |
| D7240 |
Removal of impacted tooth - completely bony |
364 |
129 |
$69K |
| D2330 |
|
673 |
357 |
$43K |
| D2160 |
|
356 |
310 |
$40K |
| D9239 |
|
533 |
511 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
176 |
140 |
$23K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
250 |
129 |
$19K |
| D9610 |
|
534 |
512 |
$18K |
| D2332 |
|
94 |
58 |
$9K |
| D9420 |
|
65 |
46 |
$6K |
| D1354 |
|
649 |
186 |
$5K |
| D0350 |
|
15,706 |
15,248 |
$2K |
| D7286 |
|
24 |
24 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
12 |
$2K |
| D1999 |
|
186 |
183 |
$0.00 |