| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
15,258 |
15,199 |
$545K |
| D0120 |
Periodic oral evaluation - established patient |
21,981 |
21,897 |
$468K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
7,268 |
3,921 |
$376K |
| D1110 |
Prophylaxis - adult |
13,949 |
13,893 |
$321K |
| D1120 |
Prophylaxis - child |
12,305 |
12,261 |
$231K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,340 |
14,287 |
$156K |
| D7111 |
|
2,373 |
1,387 |
$117K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,069 |
475 |
$110K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,641 |
3,633 |
$101K |
| D0272 |
Bitewings - two radiographic images |
10,529 |
10,470 |
$82K |
| D2160 |
|
1,324 |
894 |
$81K |
| D2140 |
|
1,686 |
1,146 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
15,656 |
15,534 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,513 |
13,764 |
$50K |
| D9920 |
|
3,658 |
1,760 |
$50K |
| D2752 |
|
116 |
103 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
648 |
412 |
$48K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,170 |
527 |
$47K |
| D0603 |
|
3,651 |
3,639 |
$36K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
437 |
172 |
$27K |
| D0601 |
|
2,046 |
2,032 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
397 |
242 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
185 |
128 |
$16K |
| D0602 |
|
1,221 |
1,219 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
167 |
108 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
325 |
324 |
$9K |
| D2331 |
|
150 |
106 |
$8K |
| D2950 |
|
87 |
82 |
$6K |
| D9222 |
|
91 |
91 |
$5K |
| D2332 |
|
77 |
51 |
$5K |
| D3320 |
|
12 |
12 |
$4K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
50 |
50 |
$3K |
| D2330 |
|
66 |
44 |
$3K |
| D0270 |
|
725 |
725 |
$3K |
| D0191 |
|
33 |
33 |
$495.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$210.00 |
| D9610 |
|
79 |
79 |
$158.00 |
| D1330 |
|
11,742 |
11,636 |
$0.00 |
| D3120 |
|
85 |
73 |
$0.00 |