| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
22,211 |
22,157 |
$1.27M |
| D1120 |
Prophylaxis - child |
27,137 |
27,050 |
$1.04M |
| D0230 |
Intraoral - periapical each additional radiographic image |
160,782 |
27,881 |
$656K |
| D1351 |
Sealant - per tooth |
20,642 |
7,019 |
$581K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,875 |
3,814 |
$455K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,140 |
7,124 |
$448K |
| D2140 |
|
8,089 |
4,583 |
$435K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,668 |
1,365 |
$310K |
| D1310 |
|
6,413 |
6,395 |
$292K |
| D1110 |
Prophylaxis - adult |
3,385 |
3,373 |
$291K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,569 |
6,353 |
$258K |
| D0274 |
Bitewings - four radiographic images |
11,955 |
11,916 |
$255K |
| D9993 |
|
3,809 |
3,804 |
$245K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,491 |
1,248 |
$244K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,112 |
2,295 |
$233K |
| D1206 |
Topical application of fluoride varnish |
12,163 |
12,122 |
$223K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,489 |
18,448 |
$198K |
| D0350 |
|
17,895 |
9,123 |
$195K |
| D7240 |
Removal of impacted tooth - completely bony |
735 |
310 |
$169K |
| D0210 |
Intraoral - complete series of radiographic images |
3,160 |
3,156 |
$146K |
| D0220 |
Intraoral - periapical first radiographic image |
7,326 |
7,284 |
$83K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,042 |
1,040 |
$57K |
| D8670 |
Periodic orthodontic treatment visit |
194 |
194 |
$56K |
| D0330 |
Panoramic radiographic image |
1,521 |
1,521 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,175 |
1,175 |
$41K |
| D0272 |
Bitewings - two radiographic images |
3,192 |
3,189 |
$37K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
307 |
165 |
$36K |
| D0603 |
|
2,432 |
2,430 |
$36K |
| D0602 |
|
1,471 |
1,463 |
$22K |
| D9430 |
|
523 |
517 |
$17K |
| D4910 |
|
217 |
217 |
$17K |
| D1354 |
|
479 |
479 |
$16K |
| D4341 |
|
213 |
57 |
$15K |
| D0340 |
|
291 |
291 |
$14K |
| D7230 |
|
68 |
38 |
$13K |
| D2330 |
|
128 |
83 |
$10K |
| D2160 |
|
99 |
76 |
$8K |
| D0601 |
|
416 |
415 |
$6K |
| D4342 |
|
76 |
21 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
52 |
25 |
$3K |
| D1320 |
|
17 |
17 |
$297.50 |