| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
42,457 |
42,266 |
$2.69M |
| D1120 |
Prophylaxis - child |
60,930 |
60,687 |
$2.61M |
| D1310 |
|
31,673 |
31,544 |
$1.42M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15,244 |
15,209 |
$1.02M |
| D0230 |
Intraoral - periapical each additional radiographic image |
252,732 |
58,317 |
$1.02M |
| D1208 |
Topical application of fluoride, excluding varnish |
54,754 |
54,540 |
$906K |
| D9993 |
|
11,922 |
11,903 |
$695K |
| D1351 |
Sealant - per tooth |
22,877 |
6,372 |
$669K |
| D0220 |
Intraoral - periapical first radiographic image |
57,269 |
55,702 |
$662K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,809 |
6,207 |
$570K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,512 |
12,473 |
$531K |
| D0145 |
Oral evaluation for a patient under three years of age |
7,140 |
7,118 |
$475K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,956 |
5,696 |
$443K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,265 |
2,614 |
$377K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,414 |
4,347 |
$336K |
| D0603 |
|
18,812 |
18,733 |
$274K |
| D9430 |
|
8,607 |
8,159 |
$270K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,447 |
1,901 |
$234K |
| D0330 |
Panoramic radiographic image |
6,118 |
6,070 |
$176K |
| D0601 |
|
10,267 |
10,220 |
$151K |
| D0350 |
|
15,706 |
11,422 |
$151K |
| D2940 |
|
2,253 |
1,446 |
$123K |
| D1510 |
|
733 |
696 |
$118K |
| D2330 |
|
1,234 |
709 |
$92K |
| D0602 |
|
2,594 |
2,588 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,584 |
2,581 |
$30K |
| D7111 |
|
306 |
245 |
$17K |
| D0274 |
Bitewings - four radiographic images |
666 |
666 |
$13K |
| D0340 |
|
219 |
219 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
250 |
250 |
$9K |
| D1354 |
|
792 |
308 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
25 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
39 |
30 |
$3K |
| D9110 |
|
114 |
114 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
41 |
41 |
$2K |
| D2332 |
|
15 |
13 |
$1K |
| D2331 |
|
18 |
13 |
$1K |
| D1999 |
|
88 |
87 |
$421.50 |
| D1550 |
|
13 |
12 |
$360.00 |