| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
64,814 |
63,179 |
$1.67M |
| D1120 |
Prophylaxis - child |
49,972 |
48,578 |
$1.35M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,045 |
5,430 |
$1.30M |
| D1206 |
Topical application of fluoride varnish |
61,475 |
59,607 |
$997K |
| D1110 |
Prophylaxis - adult |
24,471 |
23,770 |
$925K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
20,353 |
19,380 |
$900K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,010 |
4,968 |
$816K |
| D1351 |
Sealant - per tooth |
28,676 |
7,386 |
$807K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,675 |
5,222 |
$739K |
| D0220 |
Intraoral - periapical first radiographic image |
46,051 |
44,685 |
$688K |
| D0330 |
Panoramic radiographic image |
11,574 |
11,256 |
$595K |
| D0274 |
Bitewings - four radiographic images |
14,672 |
14,229 |
$458K |
| D0272 |
Bitewings - two radiographic images |
23,893 |
23,331 |
$434K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,105 |
3,221 |
$386K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,645 |
3,745 |
$358K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,815 |
6,575 |
$295K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,513 |
20,352 |
$294K |
| D2140 |
|
4,041 |
2,893 |
$289K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,641 |
1,234 |
$213K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,740 |
12,505 |
$200K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,157 |
2,305 |
$83K |
| D0140 |
Limited oral evaluation - problem focused |
2,165 |
2,099 |
$80K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
529 |
380 |
$41K |
| D2160 |
|
170 |
132 |
$19K |
| D2330 |
|
153 |
117 |
$10K |
| D2332 |
|
100 |
65 |
$9K |
| D0350 |
|
15,406 |
14,934 |
$4K |
| D2394 |
|
16 |
14 |
$3K |
| D2335 |
|
14 |
12 |
$2K |
| D7111 |
|
32 |
26 |
$2K |
| D4355 |
|
16 |
16 |
$1K |
| D9995 |
|
21 |
15 |
$913.82 |
| D9440 |
|
13 |
13 |
$834.73 |
| D4346 |
|
14 |
13 |
$412.85 |
| D1999 |
|
177 |
176 |
$0.00 |