| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
43,330 |
43,012 |
$2.59M |
| D1120 |
Prophylaxis - child |
63,624 |
62,902 |
$2.58M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,461 |
5,728 |
$1.45M |
| D1310 |
|
31,794 |
31,454 |
$1.44M |
| D9993 |
|
15,584 |
15,408 |
$998K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
9,945 |
4,895 |
$968K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,123 |
13,061 |
$826K |
| D1208 |
Topical application of fluoride, excluding varnish |
46,694 |
46,322 |
$813K |
| D0230 |
Intraoral - periapical each additional radiographic image |
171,031 |
45,695 |
$717K |
| D0145 |
Oral evaluation for a patient under three years of age |
7,683 |
7,651 |
$486K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,741 |
3,802 |
$377K |
| D1351 |
Sealant - per tooth |
10,234 |
2,842 |
$369K |
| D0603 |
|
23,469 |
23,199 |
$345K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,611 |
3,490 |
$313K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,817 |
7,696 |
$307K |
| D0272 |
Bitewings - two radiographic images |
22,562 |
22,293 |
$262K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,980 |
2,146 |
$256K |
| D0220 |
Intraoral - periapical first radiographic image |
17,122 |
16,924 |
$200K |
| D2160 |
|
2,445 |
1,858 |
$192K |
| D0274 |
Bitewings - four radiographic images |
8,941 |
8,813 |
$188K |
| D1206 |
Topical application of fluoride varnish |
14,644 |
14,307 |
$185K |
| D0602 |
|
7,309 |
7,266 |
$108K |
| D0350 |
|
10,545 |
6,159 |
$108K |
| D2140 |
|
1,913 |
1,349 |
$103K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,918 |
1,212 |
$100K |
| D2330 |
|
1,225 |
714 |
$93K |
| D9430 |
|
1,429 |
1,424 |
$45K |
| D2929 |
|
397 |
156 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
375 |
313 |
$29K |
| D1510 |
|
127 |
110 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
348 |
348 |
$17K |
| D2331 |
|
172 |
123 |
$13K |
| D1320 |
|
612 |
612 |
$6K |
| D0601 |
|
124 |
112 |
$2K |
| D2332 |
|
19 |
12 |
$1K |
| D2161 |
|
16 |
14 |
$1K |
| D1999 |
|
307 |
307 |
$575.00 |