| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
34,105 |
33,912 |
$1.97M |
| D2751 |
Crown - porcelain fused to predominantly base metal |
3,473 |
2,488 |
$1.64M |
| D1120 |
Prophylaxis - child |
38,427 |
38,260 |
$1.51M |
| D0230 |
Intraoral - periapical each additional radiographic image |
219,209 |
42,983 |
$919K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
2,002 |
1,702 |
$916K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,260 |
2,735 |
$717K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,440 |
2,272 |
$642K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,489 |
9,450 |
$608K |
| D1208 |
Topical application of fluoride, excluding varnish |
42,500 |
42,302 |
$600K |
| D1351 |
Sealant - per tooth |
18,912 |
5,042 |
$591K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
8,695 |
3,680 |
$571K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,527 |
2,265 |
$533K |
| D7111 |
|
8,316 |
3,972 |
$473K |
| D1310 |
|
9,890 |
9,836 |
$444K |
| D0272 |
Bitewings - two radiographic images |
34,081 |
33,944 |
$403K |
| D8670 |
Periodic orthodontic treatment visit |
1,199 |
1,194 |
$335K |
| D2954 |
|
3,112 |
2,279 |
$326K |
| D9993 |
|
4,732 |
4,728 |
$297K |
| D3320 |
|
793 |
639 |
$285K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,424 |
6,313 |
$253K |
| D7240 |
Removal of impacted tooth - completely bony |
809 |
324 |
$187K |
| D4341 |
|
2,690 |
728 |
$182K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,684 |
1,218 |
$180K |
| D1110 |
Prophylaxis - adult |
1,728 |
1,721 |
$148K |
| D2160 |
|
1,891 |
1,055 |
$145K |
| D4910 |
|
1,721 |
1,713 |
$142K |
| D0603 |
|
6,839 |
6,794 |
$101K |
| D0140 |
Limited oral evaluation - problem focused |
2,626 |
2,620 |
$88K |
| D0340 |
|
1,664 |
1,658 |
$83K |
| D0220 |
Intraoral - periapical first radiographic image |
6,876 |
6,825 |
$82K |
| D0330 |
Panoramic radiographic image |
2,556 |
2,549 |
$74K |
| D9430 |
|
2,143 |
2,126 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
1,309 |
1,305 |
$62K |
| D3310 |
|
174 |
110 |
$52K |
| D7230 |
|
274 |
144 |
$52K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
422 |
266 |
$34K |
| D0145 |
Oral evaluation for a patient under three years of age |
372 |
366 |
$22K |
| D4342 |
|
430 |
127 |
$17K |
| D0602 |
|
865 |
865 |
$13K |
| D1510 |
|
77 |
63 |
$10K |
| D2933 |
|
97 |
36 |
$10K |
| D1206 |
Topical application of fluoride varnish |
481 |
481 |
$7K |
| D2140 |
|
132 |
72 |
$7K |
| D1354 |
|
193 |
192 |
$7K |
| D0350 |
|
508 |
297 |
$5K |
| D2161 |
|
58 |
42 |
$5K |
| D2330 |
|
56 |
28 |
$4K |
| D0601 |
|
208 |
208 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
54 |
41 |
$3K |
| D5750 |
|
13 |
13 |
$3K |
| D5850 |
|
30 |
30 |
$2K |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$259.20 |
| D9310 |
|
40 |
40 |
$0.00 |