| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
54,740 |
54,222 |
$3.03M |
| D1120 |
Prophylaxis - child |
63,725 |
63,056 |
$2.43M |
| D0230 |
Intraoral - periapical each additional radiographic image |
250,994 |
61,249 |
$1.01M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,986 |
9,038 |
$977K |
| D1208 |
Topical application of fluoride, excluding varnish |
63,322 |
62,648 |
$811K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
20,602 |
19,561 |
$800K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,261 |
3,150 |
$721K |
| D1351 |
Sealant - per tooth |
23,874 |
6,987 |
$702K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12,733 |
7,904 |
$673K |
| D8670 |
Periodic orthodontic treatment visit |
2,190 |
2,185 |
$631K |
| D0272 |
Bitewings - two radiographic images |
44,369 |
43,810 |
$508K |
| D1310 |
|
10,982 |
10,955 |
$478K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,090 |
7,026 |
$445K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,690 |
3,919 |
$376K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,308 |
1,119 |
$319K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
676 |
574 |
$307K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,071 |
2,005 |
$262K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
749 |
364 |
$231K |
| D9993 |
|
3,987 |
3,981 |
$231K |
| D0274 |
Bitewings - four radiographic images |
10,044 |
10,008 |
$213K |
| D9430 |
|
4,594 |
4,393 |
$140K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,335 |
2,315 |
$137K |
| D0140 |
Limited oral evaluation - problem focused |
3,447 |
3,447 |
$121K |
| D0220 |
Intraoral - periapical first radiographic image |
9,590 |
9,449 |
$112K |
| D0603 |
|
7,255 |
7,233 |
$104K |
| D7111 |
|
1,856 |
1,090 |
$102K |
| D9221 |
|
386 |
182 |
$88K |
| D0330 |
Panoramic radiographic image |
2,876 |
2,874 |
$85K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
175 |
138 |
$83K |
| D2954 |
|
754 |
591 |
$71K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
890 |
427 |
$67K |
| D2330 |
|
799 |
411 |
$61K |
| D9222 |
|
362 |
362 |
$44K |
| D9220 |
|
163 |
163 |
$38K |
| D7240 |
Removal of impacted tooth - completely bony |
167 |
68 |
$38K |
| D0350 |
|
4,238 |
2,757 |
$35K |
| D2931 |
|
291 |
240 |
$35K |
| D0601 |
|
1,877 |
1,870 |
$25K |
| D2140 |
|
304 |
180 |
$15K |
| D2331 |
|
165 |
118 |
$13K |
| D1510 |
|
56 |
53 |
$11K |
| D9610 |
|
83 |
83 |
$7K |
| D2160 |
|
61 |
52 |
$4K |
| D9920 |
|
29 |
28 |
$4K |
| D0602 |
|
303 |
303 |
$4K |
| D1354 |
|
265 |
92 |
$3K |
| D2394 |
|
23 |
14 |
$1K |
| D9248 |
|
12 |
12 |
$385.00 |
| D1556 |
|
12 |
12 |
$315.00 |