| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
45,545 |
45,389 |
$2.57M |
| D1120 |
Prophylaxis - child |
54,489 |
54,241 |
$2.06M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
20,444 |
7,350 |
$2.01M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16,711 |
6,823 |
$1.96M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15,468 |
8,188 |
$1.03M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
21,637 |
21,325 |
$832K |
| D1351 |
Sealant - per tooth |
29,949 |
10,128 |
$802K |
| D1310 |
|
17,214 |
17,142 |
$772K |
| D0230 |
Intraoral - periapical each additional radiographic image |
84,580 |
54,365 |
$767K |
| D7140 |
Extraction, erupted tooth or exposed root |
12,429 |
6,598 |
$703K |
| D1208 |
Topical application of fluoride, excluding varnish |
51,141 |
50,872 |
$703K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,699 |
9,662 |
$633K |
| D9993 |
|
9,160 |
9,150 |
$575K |
| D0272 |
Bitewings - two radiographic images |
35,280 |
34,912 |
$408K |
| D2160 |
|
5,048 |
3,412 |
$399K |
| D7111 |
|
6,714 |
3,895 |
$381K |
| D2933 |
|
3,456 |
1,439 |
$362K |
| D2140 |
|
6,385 |
4,416 |
$344K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,658 |
4,643 |
$286K |
| D1510 |
|
1,961 |
1,659 |
$262K |
| D0274 |
Bitewings - four radiographic images |
8,834 |
8,824 |
$186K |
| D0603 |
|
11,180 |
11,131 |
$163K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,462 |
1,375 |
$160K |
| D2330 |
|
2,020 |
1,344 |
$154K |
| D0350 |
|
11,434 |
7,994 |
$140K |
| D0220 |
Intraoral - periapical first radiographic image |
9,015 |
8,917 |
$108K |
| D0140 |
Limited oral evaluation - problem focused |
2,410 |
2,409 |
$84K |
| D0601 |
|
5,273 |
5,258 |
$78K |
| D9430 |
|
1,798 |
1,769 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,065 |
710 |
$56K |
| D1206 |
Topical application of fluoride varnish |
3,032 |
3,032 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
587 |
403 |
$45K |
| D1515 |
|
137 |
123 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
524 |
523 |
$24K |
| D2332 |
|
173 |
130 |
$14K |
| D2161 |
|
122 |
99 |
$10K |
| D0270 |
|
1,826 |
1,797 |
$9K |
| D8670 |
Periodic orthodontic treatment visit |
24 |
24 |
$7K |
| D1354 |
|
270 |
269 |
$7K |
| D0330 |
Panoramic radiographic image |
101 |
101 |
$3K |
| D0602 |
|
175 |
173 |
$3K |
| D1517 |
|
12 |
12 |
$2K |
| D1555 |
|
29 |
27 |
$120.00 |
| D1330 |
|
33 |
33 |
$0.00 |
| DR01 |
|
12 |
12 |
$0.00 |