| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
24,119 |
24,071 |
$1.35M |
| D1120 |
Prophylaxis - child |
33,831 |
33,759 |
$1.33M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
10,771 |
6,465 |
$718K |
| D0230 |
Intraoral - periapical each additional radiographic image |
153,757 |
30,968 |
$624K |
| D1351 |
Sealant - per tooth |
16,421 |
6,185 |
$468K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,727 |
6,714 |
$429K |
| D1206 |
Topical application of fluoride varnish |
23,423 |
23,354 |
$370K |
| D2140 |
|
6,765 |
4,493 |
$368K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,460 |
7,137 |
$294K |
| D1310 |
|
6,075 |
6,052 |
$271K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,134 |
1,242 |
$252K |
| D0272 |
Bitewings - two radiographic images |
17,684 |
17,646 |
$208K |
| D8670 |
Periodic orthodontic treatment visit |
564 |
564 |
$159K |
| D9993 |
|
2,545 |
2,540 |
$157K |
| D0220 |
Intraoral - periapical first radiographic image |
13,175 |
12,930 |
$156K |
| D7111 |
|
2,225 |
1,572 |
$127K |
| D0350 |
|
12,335 |
7,295 |
$118K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,131 |
694 |
$112K |
| D2160 |
|
1,190 |
904 |
$94K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,360 |
883 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,681 |
9,680 |
$77K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
158 |
156 |
$70K |
| D0603 |
|
6,188 |
6,160 |
$65K |
| D2330 |
|
792 |
527 |
$59K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,007 |
1,007 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
1,121 |
1,121 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,805 |
1,787 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
380 |
257 |
$21K |
| D9222 |
|
156 |
156 |
$19K |
| D0330 |
Panoramic radiographic image |
610 |
608 |
$17K |
| D9430 |
|
405 |
399 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
195 |
121 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
325 |
324 |
$11K |
| D9610 |
|
127 |
125 |
$10K |
| D0601 |
|
589 |
589 |
$8K |
| D2331 |
|
58 |
40 |
$5K |
| D0602 |
|
195 |
195 |
$3K |
| D0270 |
|
83 |
82 |
$410.00 |
| D1999 |
|
3,802 |
3,717 |
$212.50 |
| D9110 |
|
13 |
13 |
$189.00 |
| D1330 |
|
16,233 |
16,217 |
$0.00 |