| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
27,965 |
27,863 |
$1.51M |
| D1120 |
Prophylaxis - child |
31,568 |
31,431 |
$1.20M |
| D0230 |
Intraoral - periapical each additional radiographic image |
177,053 |
32,824 |
$733K |
| D1351 |
Sealant - per tooth |
23,641 |
8,656 |
$644K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
7,027 |
3,638 |
$464K |
| D1208 |
Topical application of fluoride, excluding varnish |
32,341 |
32,198 |
$411K |
| D2140 |
|
6,932 |
3,932 |
$364K |
| D0274 |
Bitewings - four radiographic images |
14,947 |
14,894 |
$316K |
| D1310 |
|
5,229 |
5,217 |
$238K |
| D9993 |
|
3,844 |
3,835 |
$176K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,108 |
1,300 |
$120K |
| D0220 |
Intraoral - periapical first radiographic image |
9,632 |
9,563 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,812 |
1,808 |
$104K |
| D0350 |
|
10,069 |
5,950 |
$99K |
| D0272 |
Bitewings - two radiographic images |
8,343 |
8,315 |
$97K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
742 |
412 |
$85K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
689 |
387 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,270 |
807 |
$66K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,368 |
1,313 |
$50K |
| D0603 |
|
2,509 |
2,503 |
$37K |
| D0145 |
Oral evaluation for a patient under three years of age |
299 |
298 |
$14K |
| D2160 |
|
179 |
119 |
$14K |
| D0602 |
|
896 |
896 |
$13K |
| D2330 |
|
134 |
85 |
$10K |
| D9430 |
|
203 |
201 |
$6K |
| D1110 |
Prophylaxis - adult |
38 |
38 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
61 |
61 |
$3K |
| D0601 |
|
88 |
88 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
12 |
$1K |