| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
16,442 |
16,366 |
$1.05M |
| D1120 |
Prophylaxis - child |
23,432 |
23,336 |
$1.01M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,845 |
2,464 |
$573K |
| D0230 |
Intraoral - periapical each additional radiographic image |
108,841 |
21,973 |
$465K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,235 |
23,139 |
$382K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,742 |
5,733 |
$375K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,956 |
7,525 |
$316K |
| D1310 |
|
6,738 |
6,698 |
$305K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,101 |
2,265 |
$271K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,553 |
1,397 |
$251K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,301 |
2,393 |
$243K |
| D1351 |
Sealant - per tooth |
6,570 |
1,775 |
$201K |
| D0272 |
Bitewings - two radiographic images |
15,798 |
15,718 |
$186K |
| D9993 |
|
2,012 |
2,012 |
$127K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,739 |
1,736 |
$116K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,167 |
1,409 |
$116K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,530 |
716 |
$101K |
| D0274 |
Bitewings - four radiographic images |
2,709 |
2,709 |
$58K |
| D0603 |
|
3,765 |
3,732 |
$55K |
| D9430 |
|
1,626 |
1,598 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
3,394 |
3,374 |
$40K |
| D0601 |
|
2,378 |
2,370 |
$36K |
| D8670 |
Periodic orthodontic treatment visit |
91 |
90 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
706 |
706 |
$25K |
| D0330 |
Panoramic radiographic image |
628 |
628 |
$19K |
| D1510 |
|
98 |
86 |
$12K |
| D2330 |
|
110 |
50 |
$8K |
| D0350 |
|
788 |
451 |
$6K |
| D2160 |
|
57 |
44 |
$4K |
| D2331 |
|
45 |
39 |
$4K |
| D2140 |
|
60 |
39 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
36 |
26 |
$3K |