| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
24,219 |
24,109 |
$1.40M |
| D1120 |
Prophylaxis - child |
28,614 |
28,471 |
$1.16M |
| D1310 |
|
10,581 |
10,535 |
$480K |
| D1206 |
Topical application of fluoride varnish |
15,018 |
14,951 |
$272K |
| D9993 |
|
4,145 |
4,140 |
$263K |
| D1351 |
Sealant - per tooth |
8,073 |
2,490 |
$239K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,316 |
3,300 |
$215K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,649 |
19,120 |
$199K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,949 |
14,859 |
$180K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,691 |
1,489 |
$151K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,288 |
550 |
$148K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,126 |
1,164 |
$138K |
| D0272 |
Bitewings - two radiographic images |
11,144 |
11,099 |
$127K |
| D0603 |
|
7,437 |
7,399 |
$110K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,506 |
1,498 |
$97K |
| D0220 |
Intraoral - periapical first radiographic image |
6,584 |
6,484 |
$77K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,421 |
1,375 |
$56K |
| D0274 |
Bitewings - four radiographic images |
2,540 |
2,530 |
$53K |
| D9248 |
|
1,295 |
1,219 |
$44K |
| D0350 |
|
2,854 |
2,402 |
$43K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
586 |
312 |
$37K |
| D9430 |
|
1,129 |
1,109 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
561 |
410 |
$30K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
228 |
75 |
$22K |
| D0602 |
|
1,051 |
1,050 |
$15K |
| D0330 |
Panoramic radiographic image |
156 |
156 |
$4K |
| D2140 |
|
58 |
41 |
$3K |
| D9420 |
|
45 |
43 |
$3K |
| D0601 |
|
148 |
148 |
$2K |
| D0270 |
|
258 |
254 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$384.00 |