| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
23,655 |
22,239 |
$600K |
| D1120 |
Prophylaxis - child |
13,200 |
12,335 |
$449K |
| D1110 |
Prophylaxis - adult |
9,727 |
9,245 |
$445K |
| D0272 |
Bitewings - two radiographic images |
19,991 |
18,851 |
$436K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,320 |
20,063 |
$407K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,882 |
3,241 |
$306K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,886 |
9,006 |
$240K |
| D9248 |
|
2,459 |
2,219 |
$191K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,388 |
665 |
$183K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,402 |
1,462 |
$181K |
| D0210 |
Intraoral - complete series of radiographic images |
1,863 |
1,789 |
$149K |
| D2140 |
|
2,088 |
1,358 |
$126K |
| D8670 |
Periodic orthodontic treatment visit |
1,138 |
742 |
$123K |
| D0140 |
Limited oral evaluation - problem focused |
2,617 |
2,417 |
$81K |
| D0220 |
Intraoral - periapical first radiographic image |
4,491 |
4,166 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
690 |
479 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
675 |
495 |
$40K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
432 |
234 |
$36K |
| D0274 |
Bitewings - four radiographic images |
944 |
914 |
$17K |
| D0330 |
Panoramic radiographic image |
801 |
778 |
$12K |
| D7111 |
|
240 |
131 |
$11K |
| D0250 |
|
179 |
139 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
626 |
424 |
$7K |
| D9920 |
|
374 |
366 |
$7K |
| D2332 |
|
53 |
26 |
$6K |
| D2330 |
|
61 |
38 |
$4K |
| D2331 |
|
30 |
13 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
57 |
56 |
$2K |
| D9110 |
|
27 |
27 |
$1K |
| D1351 |
Sealant - per tooth |
38 |
27 |
$1K |