| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
43,721 |
42,535 |
$1.13M |
| D1206 |
Topical application of fluoride varnish |
44,726 |
43,010 |
$815K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
12,935 |
7,832 |
$812K |
| D1120 |
Prophylaxis - child |
36,007 |
34,684 |
$799K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,162 |
6,730 |
$790K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
8,304 |
2,740 |
$741K |
| D1351 |
Sealant - per tooth |
35,864 |
9,791 |
$689K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,578 |
1,230 |
$671K |
| D1110 |
Prophylaxis - adult |
16,550 |
15,797 |
$642K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16,516 |
15,300 |
$570K |
| D0330 |
Panoramic radiographic image |
18,863 |
17,845 |
$552K |
| D0220 |
Intraoral - periapical first radiographic image |
55,401 |
51,434 |
$437K |
| D2140 |
|
8,709 |
5,498 |
$430K |
| D0140 |
Limited oral evaluation - problem focused |
16,425 |
15,408 |
$371K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,341 |
3,046 |
$297K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,420 |
3,674 |
$290K |
| D0274 |
Bitewings - four radiographic images |
22,184 |
21,092 |
$261K |
| D9999 |
Unspecified adjunctive procedure, by report |
10,848 |
10,437 |
$256K |
| D2160 |
|
3,224 |
2,476 |
$249K |
| D0272 |
Bitewings - two radiographic images |
23,894 |
23,131 |
$228K |
| D7240 |
Removal of impacted tooth - completely bony |
1,664 |
692 |
$226K |
| D2331 |
|
2,195 |
1,320 |
$148K |
| D7230 |
|
1,203 |
700 |
$133K |
| D0230 |
Intraoral - periapical each additional radiographic image |
53,286 |
47,626 |
$114K |
| D7311 |
|
580 |
344 |
$97K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
955 |
814 |
$89K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,676 |
3,310 |
$82K |
| D1999 |
|
6,260 |
5,372 |
$78K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
802 |
410 |
$70K |
| D2330 |
|
1,152 |
680 |
$47K |
| D9920 |
|
1,983 |
1,926 |
$41K |
| D2332 |
|
338 |
226 |
$30K |
| D2335 |
|
255 |
183 |
$18K |
| D2390 |
|
52 |
16 |
$8K |
| D5110 |
|
26 |
12 |
$7K |
| D7310 |
|
35 |
12 |
$6K |
| D1354 |
|
1,222 |
279 |
$4K |
| D0270 |
|
647 |
624 |
$3K |
| D7220 |
|
35 |
24 |
$3K |
| D7250 |
|
14 |
13 |
$2K |
| D4346 |
|
12 |
12 |
$960.00 |
| D7111 |
|
15 |
12 |
$502.95 |
| D4211 |
|
21 |
12 |
$0.00 |
| D1330 |
|
23 |
23 |
$0.00 |