| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
21,067 |
21,006 |
$1.15M |
| D1120 |
Prophylaxis - child |
23,937 |
23,825 |
$913K |
| D0230 |
Intraoral - periapical each additional radiographic image |
130,241 |
24,625 |
$541K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
7,631 |
3,867 |
$510K |
| D1351 |
Sealant - per tooth |
16,167 |
5,954 |
$441K |
| D2140 |
|
6,179 |
3,632 |
$336K |
| D1208 |
Topical application of fluoride, excluding varnish |
24,180 |
24,067 |
$309K |
| D0274 |
Bitewings - four radiographic images |
10,000 |
9,966 |
$214K |
| D1310 |
|
4,300 |
4,281 |
$195K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,402 |
705 |
$166K |
| D9993 |
|
2,607 |
2,599 |
$153K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,179 |
605 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,682 |
1,677 |
$108K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,777 |
1,159 |
$101K |
| D0272 |
Bitewings - two radiographic images |
8,088 |
8,059 |
$95K |
| D0220 |
Intraoral - periapical first radiographic image |
6,281 |
6,228 |
$74K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,528 |
1,484 |
$58K |
| D0603 |
|
2,242 |
2,231 |
$33K |
| D0350 |
|
2,113 |
1,451 |
$20K |
| D0145 |
Oral evaluation for a patient under three years of age |
220 |
219 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
145 |
105 |
$8K |
| D2160 |
|
98 |
69 |
$8K |
| D2330 |
|
101 |
64 |
$8K |
| D0602 |
|
457 |
456 |
$7K |
| D0601 |
|
312 |
312 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$576.00 |