| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
14,762 |
14,684 |
$803K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
11,825 |
5,389 |
$791K |
| D1120 |
Prophylaxis - child |
16,624 |
16,542 |
$644K |
| D0230 |
Intraoral - periapical each additional radiographic image |
98,073 |
18,233 |
$401K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,568 |
1,020 |
$302K |
| D2140 |
|
5,568 |
2,880 |
$302K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,541 |
1,000 |
$251K |
| D1351 |
Sealant - per tooth |
7,823 |
2,839 |
$225K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,485 |
3,469 |
$213K |
| D0274 |
Bitewings - four radiographic images |
9,177 |
9,117 |
$193K |
| D1110 |
Prophylaxis - adult |
2,235 |
2,222 |
$185K |
| D2160 |
|
2,204 |
1,398 |
$176K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,834 |
15,750 |
$176K |
| D1310 |
|
3,316 |
3,287 |
$149K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,072 |
1,125 |
$118K |
| D9993 |
|
1,500 |
1,498 |
$91K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,059 |
2,033 |
$82K |
| D0350 |
|
9,085 |
4,356 |
$76K |
| D1206 |
Topical application of fluoride varnish |
2,977 |
2,965 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
4,864 |
4,813 |
$58K |
| D0603 |
|
2,702 |
2,684 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
784 |
784 |
$38K |
| D0272 |
Bitewings - two radiographic images |
3,153 |
3,139 |
$37K |
| D9430 |
|
984 |
962 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
430 |
182 |
$29K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
227 |
159 |
$27K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
46 |
40 |
$21K |
| D2330 |
|
187 |
118 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
192 |
189 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
125 |
74 |
$7K |
| D2161 |
|
51 |
39 |
$4K |
| D4341 |
|
45 |
12 |
$3K |
| D0602 |
|
141 |
141 |
$2K |
| D2332 |
|
16 |
14 |
$1K |
| D0601 |
|
57 |
57 |
$855.00 |