| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
20,635 |
20,602 |
$1.16M |
| D1120 |
Prophylaxis - child |
22,443 |
22,405 |
$868K |
| D0230 |
Intraoral - periapical each additional radiographic image |
131,209 |
21,698 |
$528K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,831 |
4,825 |
$506K |
| D1351 |
Sealant - per tooth |
16,571 |
6,011 |
$464K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,496 |
3,931 |
$341K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,685 |
22,646 |
$267K |
| D0274 |
Bitewings - four radiographic images |
10,522 |
10,504 |
$222K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,241 |
2,177 |
$214K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,971 |
4,671 |
$195K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,894 |
2,055 |
$163K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,379 |
2,375 |
$153K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,889 |
1,494 |
$147K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
949 |
791 |
$109K |
| D1310 |
|
2,595 |
2,590 |
$108K |
| D0350 |
|
11,729 |
6,711 |
$106K |
| D0272 |
Bitewings - two radiographic images |
8,848 |
8,833 |
$104K |
| D2140 |
|
1,791 |
1,340 |
$96K |
| D2330 |
|
856 |
554 |
$64K |
| D9430 |
|
1,580 |
1,529 |
$50K |
| D2160 |
|
556 |
470 |
$44K |
| D9993 |
|
1,031 |
1,031 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
640 |
640 |
$29K |
| D3240 |
|
297 |
255 |
$29K |
| D0603 |
|
1,153 |
1,151 |
$17K |
| D2332 |
|
180 |
118 |
$14K |
| D0601 |
|
851 |
849 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
171 |
171 |
$12K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
15 |
12 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
321 |
320 |
$4K |
| D2394 |
|
16 |
14 |
$1K |
| D0602 |
|
41 |
41 |
$615.00 |