| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
63,508 |
63,262 |
$4.13M |
| D1120 |
Prophylaxis - child |
94,301 |
93,927 |
$4.01M |
| D1310 |
|
48,669 |
48,414 |
$2.20M |
| D0230 |
Intraoral - periapical each additional radiographic image |
382,618 |
73,960 |
$1.60M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
37,298 |
35,235 |
$1.47M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
20,459 |
20,408 |
$1.35M |
| D9993 |
|
18,832 |
18,806 |
$1.20M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,180 |
12,488 |
$1.04M |
| D1206 |
Topical application of fluoride varnish |
36,696 |
36,497 |
$903K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,622 |
5,941 |
$888K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,155 |
5,576 |
$696K |
| D1208 |
Topical application of fluoride, excluding varnish |
53,700 |
53,550 |
$620K |
| D0145 |
Oral evaluation for a patient under three years of age |
9,226 |
9,199 |
$611K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
9,247 |
5,847 |
$606K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,333 |
8,238 |
$593K |
| D7111 |
|
9,832 |
7,541 |
$552K |
| D0220 |
Intraoral - periapical first radiographic image |
40,701 |
40,478 |
$474K |
| D1351 |
Sealant - per tooth |
15,960 |
4,896 |
$464K |
| D0603 |
|
31,288 |
31,066 |
$459K |
| D9430 |
|
13,933 |
13,676 |
$443K |
| D0274 |
Bitewings - four radiographic images |
15,538 |
15,517 |
$331K |
| D0601 |
|
16,925 |
16,875 |
$250K |
| D0350 |
|
24,640 |
16,906 |
$247K |
| D0272 |
Bitewings - two radiographic images |
20,016 |
19,964 |
$235K |
| D2330 |
|
2,713 |
1,574 |
$203K |
| D2140 |
|
3,776 |
2,365 |
$200K |
| D0210 |
Intraoral - complete series of radiographic images |
2,833 |
2,831 |
$132K |
| D0330 |
Panoramic radiographic image |
3,963 |
3,953 |
$115K |
| D1320 |
|
12,202 |
12,181 |
$105K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,188 |
841 |
$67K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
790 |
730 |
$62K |
| D2160 |
|
657 |
576 |
$52K |
| D2932 |
|
481 |
245 |
$50K |
| D1510 |
|
268 |
258 |
$48K |
| D2332 |
|
348 |
221 |
$29K |
| D1354 |
|
1,446 |
854 |
$27K |
| D9920 |
|
187 |
187 |
$22K |
| D2940 |
|
291 |
167 |
$18K |
| D2331 |
|
101 |
76 |
$8K |
| D1999 |
|
252 |
250 |
$150.00 |
| D0270 |
|
29 |
29 |
$145.00 |