| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
35,086 |
35,066 |
$1.99M |
| D1120 |
Prophylaxis - child |
42,483 |
42,409 |
$1.66M |
| D1351 |
Sealant - per tooth |
31,888 |
10,958 |
$913K |
| D0230 |
Intraoral - periapical each additional radiographic image |
213,536 |
41,201 |
$902K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
10,962 |
5,710 |
$736K |
| D1208 |
Topical application of fluoride, excluding varnish |
43,484 |
43,404 |
$585K |
| D2140 |
|
10,454 |
5,758 |
$570K |
| D1310 |
|
10,375 |
10,360 |
$472K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,743 |
1,734 |
$442K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,780 |
5,772 |
$376K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,730 |
1,705 |
$370K |
| D9993 |
|
7,392 |
7,385 |
$341K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,406 |
3,290 |
$309K |
| D0274 |
Bitewings - four radiographic images |
14,171 |
14,164 |
$303K |
| D0220 |
Intraoral - periapical first radiographic image |
14,694 |
14,624 |
$173K |
| D0272 |
Bitewings - two radiographic images |
12,505 |
12,490 |
$148K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,172 |
3,106 |
$124K |
| D0350 |
|
11,695 |
7,251 |
$121K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,874 |
1,873 |
$115K |
| D0603 |
|
5,523 |
5,514 |
$82K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,281 |
909 |
$69K |
| D2160 |
|
600 |
398 |
$48K |
| D0601 |
|
2,816 |
2,811 |
$42K |
| D2330 |
|
401 |
243 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
482 |
482 |
$22K |
| D1110 |
Prophylaxis - adult |
111 |
111 |
$10K |
| D0602 |
|
627 |
627 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
108 |
53 |
$7K |
| D1510 |
|
39 |
32 |
$6K |