| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
16,606 |
16,537 |
$992K |
| D1120 |
Prophylaxis - child |
23,209 |
23,131 |
$939K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
8,564 |
3,788 |
$571K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,166 |
1,544 |
$491K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,768 |
21,789 |
$465K |
| D1351 |
Sealant - per tooth |
13,660 |
4,608 |
$400K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,335 |
23,252 |
$342K |
| D2140 |
|
6,109 |
3,008 |
$331K |
| D1310 |
|
7,232 |
7,207 |
$330K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,174 |
5,172 |
$328K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,288 |
1,173 |
$323K |
| D7240 |
Removal of impacted tooth - completely bony |
1,221 |
467 |
$281K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,196 |
2,181 |
$238K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,615 |
5,546 |
$223K |
| D0274 |
Bitewings - four radiographic images |
9,196 |
9,163 |
$197K |
| D9993 |
|
3,278 |
3,277 |
$194K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,927 |
1,923 |
$124K |
| D0350 |
|
5,211 |
4,874 |
$100K |
| D0272 |
Bitewings - two radiographic images |
8,139 |
8,107 |
$95K |
| D0603 |
|
5,780 |
5,762 |
$86K |
| D8670 |
Periodic orthodontic treatment visit |
276 |
276 |
$80K |
| D2160 |
|
986 |
625 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
5,030 |
4,903 |
$60K |
| D9430 |
|
960 |
936 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
653 |
653 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
624 |
624 |
$22K |
| D2330 |
|
264 |
174 |
$20K |
| D0330 |
Panoramic radiographic image |
659 |
659 |
$19K |
| D0602 |
|
1,134 |
1,128 |
$17K |
| D0601 |
|
177 |
177 |
$3K |