| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
63,342 |
63,099 |
$3.41M |
| D1120 |
Prophylaxis - child |
77,924 |
77,656 |
$3.07M |
| D1351 |
Sealant - per tooth |
50,537 |
19,051 |
$1.46M |
| D0230 |
Intraoral - periapical each additional radiographic image |
332,320 |
71,877 |
$1.36M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18,663 |
11,108 |
$1.25M |
| D2140 |
|
17,875 |
10,704 |
$974K |
| D1206 |
Topical application of fluoride varnish |
49,125 |
48,867 |
$795K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,046 |
9,038 |
$600K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,087 |
2,881 |
$598K |
| D7111 |
|
9,667 |
5,839 |
$554K |
| D1310 |
|
11,808 |
11,765 |
$532K |
| D0272 |
Bitewings - two radiographic images |
43,050 |
42,898 |
$506K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,930 |
12,591 |
$504K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,490 |
1,961 |
$346K |
| D0220 |
Intraoral - periapical first radiographic image |
22,603 |
22,332 |
$267K |
| D8670 |
Periodic orthodontic treatment visit |
890 |
890 |
$248K |
| D0274 |
Bitewings - four radiographic images |
10,903 |
10,849 |
$235K |
| D9993 |
|
3,559 |
3,549 |
$225K |
| D1208 |
Topical application of fluoride, excluding varnish |
28,138 |
28,131 |
$224K |
| D0350 |
|
22,894 |
13,241 |
$222K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,298 |
3,292 |
$204K |
| D2160 |
|
2,324 |
1,762 |
$185K |
| D2330 |
|
2,332 |
1,501 |
$179K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,615 |
1,488 |
$176K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
380 |
374 |
$151K |
| D0603 |
|
12,286 |
12,251 |
$144K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,287 |
1,470 |
$131K |
| D9222 |
|
375 |
375 |
$46K |
| D0330 |
Panoramic radiographic image |
1,296 |
1,296 |
$38K |
| D9430 |
|
1,055 |
1,024 |
$34K |
| D9610 |
|
375 |
375 |
$32K |
| D7230 |
|
146 |
61 |
$28K |
| D7240 |
Removal of impacted tooth - completely bony |
116 |
47 |
$27K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
27 |
27 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
506 |
506 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
226 |
149 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
151 |
120 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
75 |
43 |
$9K |
| D0601 |
|
966 |
966 |
$9K |
| D1510 |
|
42 |
38 |
$7K |
| D0602 |
|
418 |
418 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
53 |
53 |
$2K |
| D0270 |
|
156 |
155 |
$780.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
243 |
242 |
$578.38 |
| D1999 |
|
7,110 |
7,058 |
$0.01 |
| D1330 |
|
39,268 |
39,236 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
226 |
225 |
$0.00 |