| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
52,685 |
52,503 |
$2.31M |
| D0120 |
Periodic oral evaluation - established patient |
33,709 |
33,576 |
$2.23M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,729 |
4,176 |
$1.16M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16,604 |
9,198 |
$1.11M |
| D1310 |
|
22,744 |
22,670 |
$1.04M |
| D0230 |
Intraoral - periapical each additional radiographic image |
45,041 |
44,802 |
$961K |
| D1351 |
Sealant - per tooth |
30,990 |
10,433 |
$957K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,644 |
13,617 |
$933K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
21,950 |
21,505 |
$872K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
8,704 |
3,797 |
$857K |
| D2140 |
|
14,109 |
8,241 |
$766K |
| D7140 |
Extraction, erupted tooth or exposed root |
11,520 |
6,855 |
$659K |
| D9993 |
|
8,547 |
8,547 |
$555K |
| D1208 |
Topical application of fluoride, excluding varnish |
37,402 |
37,277 |
$462K |
| D1206 |
Topical application of fluoride varnish |
14,865 |
14,809 |
$419K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,898 |
4,878 |
$334K |
| D0220 |
Intraoral - periapical first radiographic image |
24,627 |
24,488 |
$295K |
| D0350 |
|
14,343 |
12,962 |
$236K |
| D0603 |
|
15,477 |
15,435 |
$231K |
| D0274 |
Bitewings - four radiographic images |
10,268 |
10,224 |
$222K |
| D0210 |
Intraoral - complete series of radiographic images |
4,324 |
4,310 |
$207K |
| D0272 |
Bitewings - two radiographic images |
11,707 |
11,659 |
$140K |
| D0602 |
|
5,657 |
5,630 |
$85K |
| D2160 |
|
915 |
676 |
$73K |
| D1320 |
|
4,241 |
4,241 |
$42K |
| D2330 |
|
543 |
330 |
$42K |
| D9430 |
|
447 |
446 |
$14K |
| D1510 |
|
96 |
87 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
157 |
83 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
84 |
44 |
$5K |
| D2331 |
|
25 |
18 |
$2K |
| D2332 |
|
21 |
15 |
$2K |
| D0270 |
|
154 |
148 |
$770.00 |
| D0601 |
|
12 |
12 |
$180.00 |