| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
19,668 |
19,605 |
$1.09M |
| D1120 |
Prophylaxis - child |
21,635 |
21,558 |
$823K |
| D0230 |
Intraoral - periapical each additional radiographic image |
111,291 |
20,168 |
$450K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,548 |
3,708 |
$435K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,394 |
5,267 |
$213K |
| D0274 |
Bitewings - four radiographic images |
8,326 |
8,304 |
$176K |
| D1206 |
Topical application of fluoride varnish |
11,888 |
11,881 |
$154K |
| D7240 |
Removal of impacted tooth - completely bony |
630 |
269 |
$145K |
| D2140 |
|
2,385 |
1,533 |
$129K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,537 |
10,481 |
$122K |
| D1310 |
|
2,591 |
2,586 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,878 |
1,876 |
$114K |
| D9993 |
|
1,617 |
1,615 |
$104K |
| D0210 |
Intraoral - complete series of radiographic images |
2,209 |
2,197 |
$101K |
| D1351 |
Sealant - per tooth |
3,630 |
1,296 |
$96K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
650 |
273 |
$65K |
| D0272 |
Bitewings - two radiographic images |
5,190 |
5,176 |
$61K |
| D0350 |
|
4,593 |
2,811 |
$48K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
399 |
209 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
789 |
536 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,429 |
3,388 |
$40K |
| D0330 |
Panoramic radiographic image |
1,122 |
1,120 |
$33K |
| D9430 |
|
781 |
765 |
$24K |
| D8670 |
Periodic orthodontic treatment visit |
83 |
83 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
664 |
664 |
$23K |
| D2330 |
|
223 |
135 |
$17K |
| D2160 |
|
172 |
137 |
$14K |
| D0603 |
|
881 |
878 |
$13K |
| D1110 |
Prophylaxis - adult |
152 |
149 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
224 |
136 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
121 |
121 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
22 |
15 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28 |
14 |
$2K |
| D0602 |
|
55 |
54 |
$825.00 |
| D0601 |
|
25 |
25 |
$375.00 |
| D1320 |
|
12 |
12 |
$165.00 |