| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
33,388 |
33,271 |
$1.84M |
| D1120 |
Prophylaxis - child |
35,529 |
35,371 |
$1.37M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14,655 |
7,941 |
$982K |
| D2140 |
|
17,642 |
9,825 |
$960K |
| D0230 |
Intraoral - periapical each additional radiographic image |
201,531 |
37,744 |
$873K |
| D7140 |
Extraction, erupted tooth or exposed root |
13,379 |
6,741 |
$767K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,591 |
2,253 |
$660K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,519 |
2,223 |
$548K |
| D1208 |
Topical application of fluoride, excluding varnish |
37,791 |
37,623 |
$487K |
| D1351 |
Sealant - per tooth |
17,419 |
7,568 |
$473K |
| D8670 |
Periodic orthodontic treatment visit |
1,406 |
1,403 |
$404K |
| D0272 |
Bitewings - two radiographic images |
28,956 |
28,851 |
$341K |
| D2160 |
|
2,844 |
2,024 |
$226K |
| D1310 |
|
4,572 |
4,559 |
$208K |
| D0350 |
|
18,870 |
11,058 |
$197K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,935 |
2,930 |
$188K |
| D1110 |
Prophylaxis - adult |
1,611 |
1,599 |
$141K |
| D2330 |
|
1,644 |
1,135 |
$127K |
| D0220 |
Intraoral - periapical first radiographic image |
10,073 |
9,947 |
$118K |
| D9993 |
|
1,145 |
1,143 |
$73K |
| D0603 |
|
3,933 |
3,923 |
$58K |
| D0145 |
Oral evaluation for a patient under three years of age |
965 |
964 |
$57K |
| D4341 |
|
393 |
101 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
764 |
762 |
$27K |
| D2331 |
|
193 |
132 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
294 |
294 |
$14K |
| D0340 |
|
101 |
101 |
$5K |
| D0601 |
|
336 |
336 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
38 |
27 |
$4K |
| D0330 |
Panoramic radiographic image |
129 |
129 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
36 |
$3K |
| D1510 |
|
15 |
12 |
$2K |
| D9430 |
|
40 |
40 |
$1K |
| D0602 |
|
16 |
16 |
$240.00 |