| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
26,694 |
26,603 |
$1.50M |
| D1120 |
Prophylaxis - child |
32,756 |
32,631 |
$1.28M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
12,790 |
6,483 |
$844K |
| D0230 |
Intraoral - periapical each additional radiographic image |
157,545 |
32,041 |
$651K |
| D2140 |
|
8,113 |
4,552 |
$437K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,204 |
4,014 |
$399K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,666 |
9,411 |
$380K |
| D1310 |
|
7,747 |
7,719 |
$351K |
| D1351 |
Sealant - per tooth |
11,698 |
4,424 |
$329K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,126 |
4,119 |
$261K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,823 |
23,734 |
$252K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,837 |
1,146 |
$211K |
| D1206 |
Topical application of fluoride varnish |
8,676 |
8,642 |
$197K |
| D9993 |
|
2,831 |
2,831 |
$181K |
| D0274 |
Bitewings - four radiographic images |
8,270 |
8,243 |
$172K |
| D0272 |
Bitewings - two radiographic images |
14,657 |
14,604 |
$169K |
| D0350 |
|
14,498 |
7,645 |
$167K |
| D2160 |
|
2,058 |
1,359 |
$161K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,503 |
866 |
$146K |
| D0220 |
Intraoral - periapical first radiographic image |
12,061 |
11,835 |
$142K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,332 |
1,326 |
$84K |
| D0603 |
|
4,636 |
4,619 |
$69K |
| D0602 |
|
2,780 |
2,770 |
$41K |
| D2330 |
|
491 |
270 |
$37K |
| D9430 |
|
531 |
526 |
$17K |
| D2331 |
|
73 |
56 |
$6K |
| D1510 |
|
27 |
26 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
25 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
30 |
13 |
$351.60 |