| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
87,588 |
87,435 |
$4.91M |
| D1120 |
Prophylaxis - child |
112,476 |
112,154 |
$4.46M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
19,276 |
8,799 |
$2.26M |
| D1310 |
|
39,285 |
39,203 |
$1.79M |
| D1208 |
Topical application of fluoride, excluding varnish |
111,867 |
111,535 |
$1.67M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
16,060 |
7,684 |
$1.57M |
| D0230 |
Intraoral - periapical each additional radiographic image |
353,636 |
94,405 |
$1.47M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20,606 |
12,650 |
$1.37M |
| D9993 |
|
18,142 |
18,138 |
$1.17M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16,199 |
16,180 |
$1.05M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
20,125 |
19,711 |
$789K |
| D7140 |
Extraction, erupted tooth or exposed root |
12,398 |
7,762 |
$701K |
| D1351 |
Sealant - per tooth |
21,545 |
5,756 |
$697K |
| D0274 |
Bitewings - four radiographic images |
29,229 |
29,169 |
$620K |
| D0145 |
Oral evaluation for a patient under three years of age |
9,200 |
9,189 |
$576K |
| D2140 |
|
10,671 |
7,246 |
$574K |
| D0272 |
Bitewings - two radiographic images |
42,387 |
42,253 |
$497K |
| D0603 |
|
28,648 |
28,584 |
$426K |
| D0220 |
Intraoral - periapical first radiographic image |
27,055 |
26,924 |
$319K |
| D2160 |
|
3,959 |
3,089 |
$312K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,994 |
2,245 |
$263K |
| D1510 |
|
1,103 |
955 |
$209K |
| D0350 |
|
19,370 |
13,119 |
$193K |
| D2330 |
|
2,349 |
1,474 |
$180K |
| D0602 |
|
8,593 |
8,576 |
$128K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,610 |
1,120 |
$87K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
713 |
543 |
$56K |
| D9430 |
|
1,761 |
1,752 |
$56K |
| D1320 |
|
1,906 |
1,906 |
$19K |
| D2331 |
|
205 |
145 |
$16K |
| D0601 |
|
351 |
350 |
$5K |
| D2332 |
|
30 |
26 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$624.00 |