| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
22,746 |
22,665 |
$1.28M |
| D1120 |
Prophylaxis - child |
27,195 |
27,092 |
$1.09M |
| D7140 |
Extraction, erupted tooth or exposed root |
6,659 |
3,295 |
$371K |
| D1351 |
Sealant - per tooth |
11,880 |
4,050 |
$356K |
| D1208 |
Topical application of fluoride, excluding varnish |
25,755 |
25,654 |
$356K |
| D1310 |
|
7,197 |
7,173 |
$328K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,799 |
1,589 |
$326K |
| D0230 |
Intraoral - periapical each additional radiographic image |
73,952 |
26,745 |
$301K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,380 |
4,353 |
$278K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,650 |
2,425 |
$242K |
| D3240 |
|
2,403 |
1,420 |
$234K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,541 |
5,296 |
$218K |
| D0274 |
Bitewings - four radiographic images |
9,730 |
9,684 |
$205K |
| D9993 |
|
2,679 |
2,678 |
$170K |
| D0272 |
Bitewings - two radiographic images |
12,323 |
12,281 |
$144K |
| D0220 |
Intraoral - periapical first radiographic image |
7,563 |
7,362 |
$88K |
| D0603 |
|
5,590 |
5,569 |
$83K |
| D9430 |
|
2,190 |
2,109 |
$69K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,059 |
758 |
$69K |
| D2140 |
|
1,237 |
881 |
$66K |
| D0350 |
|
6,005 |
3,011 |
$62K |
| D0145 |
Oral evaluation for a patient under three years of age |
852 |
852 |
$51K |
| D1354 |
|
1,458 |
920 |
$31K |
| D1110 |
Prophylaxis - adult |
362 |
359 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,145 |
1,144 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
250 |
159 |
$13K |
| D2160 |
|
160 |
131 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
89 |
71 |
$7K |
| D3222 |
|
61 |
51 |
$6K |
| D1510 |
|
51 |
51 |
$6K |
| D0602 |
|
348 |
347 |
$5K |
| D0601 |
|
275 |
275 |
$4K |
| D1999 |
|
3,187 |
2,870 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
36 |
36 |
$2K |