| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
106,290 |
105,999 |
$6.21M |
| D1120 |
Prophylaxis - child |
145,253 |
144,718 |
$5.68M |
| D1310 |
|
59,618 |
59,476 |
$2.72M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34,838 |
20,532 |
$2.26M |
| D9993 |
|
32,333 |
32,325 |
$2.08M |
| D0230 |
Intraoral - periapical each additional radiographic image |
451,154 |
131,050 |
$1.84M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
42,543 |
41,161 |
$1.64M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
23,847 |
23,778 |
$1.50M |
| D1206 |
Topical application of fluoride varnish |
88,749 |
88,467 |
$1.35M |
| D1351 |
Sealant - per tooth |
40,517 |
12,613 |
$1.17M |
| D0145 |
Oral evaluation for a patient under three years of age |
16,015 |
15,962 |
$986K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18,742 |
13,120 |
$971K |
| D7140 |
Extraction, erupted tooth or exposed root |
14,344 |
10,091 |
$796K |
| D0220 |
Intraoral - periapical first radiographic image |
67,170 |
66,329 |
$782K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,088 |
4,135 |
$590K |
| D0274 |
Bitewings - four radiographic images |
27,359 |
27,252 |
$567K |
| D0603 |
|
34,691 |
34,610 |
$515K |
| D1208 |
Topical application of fluoride, excluding varnish |
51,362 |
51,114 |
$460K |
| D0272 |
Bitewings - two radiographic images |
39,780 |
39,607 |
$450K |
| D2330 |
|
6,016 |
3,643 |
$435K |
| D0350 |
|
31,886 |
20,010 |
$313K |
| D0601 |
|
12,478 |
12,451 |
$186K |
| D9430 |
|
5,898 |
5,840 |
$184K |
| D0602 |
|
10,644 |
10,633 |
$159K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,304 |
1,093 |
$121K |
| D0330 |
Panoramic radiographic image |
3,805 |
3,802 |
$105K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
957 |
833 |
$71K |
| D2331 |
|
553 |
422 |
$42K |
| D1510 |
|
473 |
404 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
955 |
954 |
$33K |
| D2390 |
|
211 |
114 |
$22K |
| D8670 |
Periodic orthodontic treatment visit |
59 |
59 |
$17K |
| D2940 |
|
259 |
201 |
$15K |
| D1354 |
|
1,530 |
622 |
$15K |
| D7111 |
|
286 |
183 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
302 |
302 |
$14K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
13 |
13 |
$13K |
| D0270 |
|
1,820 |
1,806 |
$9K |
| D0340 |
|
173 |
173 |
$9K |
| D3240 |
|
59 |
54 |
$6K |
| D2335 |
|
47 |
29 |
$6K |
| D2332 |
|
149 |
80 |
$5K |
| D0470 |
|
13 |
13 |
$975.00 |
| D1555 |
|
28 |
27 |
$660.00 |