| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
14,380 |
14,294 |
$814K |
| D1120 |
Prophylaxis - child |
16,887 |
16,780 |
$662K |
| D0230 |
Intraoral - periapical each additional radiographic image |
93,834 |
18,914 |
$392K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,727 |
1,728 |
$250K |
| D1310 |
|
3,914 |
3,885 |
$179K |
| D0274 |
Bitewings - four radiographic images |
6,500 |
6,457 |
$139K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,583 |
12,507 |
$138K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,308 |
3,236 |
$130K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,908 |
1,904 |
$121K |
| D9993 |
|
2,057 |
2,057 |
$117K |
| D1206 |
Topical application of fluoride varnish |
5,054 |
5,023 |
$111K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,342 |
837 |
$90K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,185 |
1,184 |
$69K |
| D0272 |
Bitewings - two radiographic images |
5,580 |
5,547 |
$66K |
| D2160 |
|
492 |
319 |
$39K |
| D1351 |
Sealant - per tooth |
1,391 |
466 |
$35K |
| D0603 |
|
1,913 |
1,900 |
$29K |
| D1110 |
Prophylaxis - adult |
319 |
319 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
359 |
237 |
$20K |
| D0602 |
|
943 |
943 |
$14K |
| D9430 |
|
400 |
396 |
$13K |
| D0350 |
|
962 |
684 |
$11K |
| D2140 |
|
195 |
140 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
82 |
54 |
$10K |
| D0601 |
|
635 |
634 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
202 |
202 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
131 |
102 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
509 |
508 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
53 |
41 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
65 |
56 |
$5K |
| D7111 |
|
35 |
25 |
$2K |
| D1510 |
|
12 |
12 |
$1K |