| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
15,555 |
15,448 |
$816K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,444 |
1,289 |
$686K |
| D1120 |
Prophylaxis - child |
18,183 |
18,032 |
$666K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,186 |
5,103 |
$298K |
| D1110 |
Prophylaxis - adult |
4,313 |
4,220 |
$294K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,896 |
16,766 |
$215K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,158 |
1,760 |
$211K |
| D9430 |
|
6,754 |
6,604 |
$203K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,925 |
1,341 |
$196K |
| D0230 |
Intraoral - periapical each additional radiographic image |
48,407 |
20,031 |
$189K |
| D0274 |
Bitewings - four radiographic images |
10,377 |
10,220 |
$187K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,302 |
1,372 |
$131K |
| D1310 |
|
2,682 |
2,666 |
$122K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,396 |
996 |
$75K |
| D9993 |
|
2,655 |
2,640 |
$68K |
| D0210 |
Intraoral - complete series of radiographic images |
1,479 |
1,474 |
$67K |
| D0272 |
Bitewings - two radiographic images |
5,719 |
5,684 |
$67K |
| D9248 |
|
1,875 |
1,710 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
7,273 |
6,981 |
$63K |
| D0350 |
|
5,807 |
3,120 |
$50K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
573 |
376 |
$46K |
| D0145 |
Oral evaluation for a patient under three years of age |
590 |
590 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
238 |
92 |
$31K |
| D0330 |
Panoramic radiographic image |
1,672 |
1,591 |
$28K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
233 |
183 |
$27K |
| D3348 |
|
50 |
43 |
$25K |
| D1351 |
Sealant - per tooth |
1,074 |
289 |
$24K |
| D3320 |
|
42 |
41 |
$17K |
| D0603 |
|
1,151 |
1,150 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
591 |
541 |
$15K |
| D0601 |
|
962 |
956 |
$14K |
| D9243 |
|
300 |
178 |
$14K |
| D9999 |
Unspecified adjunctive procedure, by report |
100 |
97 |
$12K |
| D4341 |
|
219 |
85 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
84 |
77 |
$8K |
| D2330 |
|
90 |
53 |
$7K |
| D2140 |
|
124 |
84 |
$7K |
| D9110 |
|
284 |
245 |
$5K |
| D7240 |
Removal of impacted tooth - completely bony |
26 |
12 |
$5K |
| D9239 |
|
93 |
93 |
$3K |
| D2160 |
|
32 |
27 |
$3K |
| D1999 |
|
4,932 |
4,398 |
$2K |
| D1206 |
Topical application of fluoride varnish |
35 |
35 |
$286.50 |
| D0270 |
|
78 |
73 |
$251.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
365 |
328 |
$46.00 |