| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
28,912 |
28,786 |
$1.62M |
| D1120 |
Prophylaxis - child |
35,890 |
35,723 |
$1.42M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14,097 |
7,521 |
$937K |
| D0230 |
Intraoral - periapical each additional radiographic image |
184,088 |
38,362 |
$785K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,576 |
3,825 |
$773K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,933 |
3,402 |
$585K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,582 |
14,118 |
$573K |
| D1310 |
|
12,347 |
12,295 |
$561K |
| D1208 |
Topical application of fluoride, excluding varnish |
35,835 |
35,668 |
$532K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,664 |
4,359 |
$379K |
| D1351 |
Sealant - per tooth |
13,661 |
5,278 |
$366K |
| D9993 |
|
5,599 |
5,596 |
$359K |
| D2140 |
|
6,139 |
3,878 |
$332K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,877 |
4,857 |
$310K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,910 |
3,529 |
$263K |
| D0274 |
Bitewings - four radiographic images |
11,300 |
11,251 |
$237K |
| D0220 |
Intraoral - periapical first radiographic image |
18,683 |
18,205 |
$220K |
| D2160 |
|
2,485 |
1,873 |
$196K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,504 |
2,497 |
$153K |
| D0272 |
Bitewings - two radiographic images |
12,684 |
12,635 |
$148K |
| D0350 |
|
12,783 |
8,464 |
$143K |
| D0603 |
|
9,220 |
9,185 |
$136K |
| D2330 |
|
1,120 |
699 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,306 |
791 |
$85K |
| D1510 |
|
626 |
578 |
$83K |
| D9430 |
|
1,335 |
1,312 |
$42K |
| D0602 |
|
1,483 |
1,479 |
$22K |
| D0601 |
|
772 |
772 |
$12K |
| D1320 |
|
762 |
759 |
$7K |
| D9920 |
|
42 |
41 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
80 |
80 |
$4K |
| D0340 |
|
77 |
77 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
59 |
59 |
$2K |
| D0330 |
Panoramic radiographic image |
79 |
79 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
25 |
20 |
$2K |
| D8660 |
|
12 |
12 |
$0.00 |