| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
24,214 |
24,133 |
$1.41M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18,137 |
7,159 |
$1.16M |
| D1120 |
Prophylaxis - child |
28,089 |
27,997 |
$1.03M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,905 |
3,360 |
$669K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,094 |
2,993 |
$485K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,931 |
10,884 |
$430K |
| D0230 |
Intraoral - periapical each additional radiographic image |
106,999 |
32,843 |
$426K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,841 |
4,219 |
$421K |
| D1208 |
Topical application of fluoride, excluding varnish |
26,989 |
26,904 |
$375K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,617 |
5,605 |
$363K |
| D2330 |
|
4,853 |
2,227 |
$352K |
| D2140 |
|
5,524 |
3,086 |
$290K |
| D1351 |
Sealant - per tooth |
10,825 |
3,119 |
$288K |
| D0272 |
Bitewings - two radiographic images |
22,394 |
22,327 |
$252K |
| D1310 |
|
5,554 |
5,514 |
$244K |
| D2332 |
|
2,907 |
1,661 |
$229K |
| D1510 |
|
1,190 |
994 |
$164K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,730 |
2,729 |
$160K |
| D0350 |
|
12,832 |
7,170 |
$157K |
| D0220 |
Intraoral - periapical first radiographic image |
13,699 |
13,452 |
$155K |
| D9430 |
|
2,761 |
2,740 |
$87K |
| D2160 |
|
1,056 |
745 |
$80K |
| D0601 |
|
3,457 |
3,438 |
$50K |
| D2335 |
|
349 |
196 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,017 |
1,008 |
$20K |
| D0602 |
|
957 |
953 |
$14K |
| D0603 |
|
725 |
725 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
26 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
14 |
$1K |