| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
31,434 |
31,370 |
$1.86M |
| D1120 |
Prophylaxis - child |
44,584 |
44,498 |
$1.77M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,048 |
4,793 |
$1.42M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
9,950 |
3,831 |
$987K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13,706 |
7,168 |
$918K |
| D1351 |
Sealant - per tooth |
30,049 |
9,501 |
$839K |
| D0230 |
Intraoral - periapical each additional radiographic image |
65,324 |
37,645 |
$799K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19,459 |
19,260 |
$770K |
| D7140 |
Extraction, erupted tooth or exposed root |
13,220 |
7,367 |
$757K |
| D2140 |
|
13,193 |
7,110 |
$718K |
| D1310 |
|
15,165 |
15,125 |
$696K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,526 |
8,518 |
$541K |
| D9993 |
|
7,879 |
7,879 |
$512K |
| D1208 |
Topical application of fluoride, excluding varnish |
35,998 |
35,943 |
$444K |
| D0220 |
Intraoral - periapical first radiographic image |
21,089 |
20,938 |
$250K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,154 |
4,147 |
$245K |
| D1206 |
Topical application of fluoride varnish |
8,225 |
8,195 |
$219K |
| D0350 |
|
13,976 |
10,672 |
$195K |
| D0603 |
|
11,138 |
11,109 |
$166K |
| D2330 |
|
2,158 |
1,308 |
$165K |
| D0272 |
Bitewings - two radiographic images |
13,880 |
13,845 |
$164K |
| D0210 |
Intraoral - complete series of radiographic images |
2,747 |
2,747 |
$129K |
| D0274 |
Bitewings - four radiographic images |
5,166 |
5,151 |
$112K |
| D1510 |
|
439 |
376 |
$59K |
| D2160 |
|
561 |
447 |
$45K |
| D0602 |
|
2,632 |
2,630 |
$39K |
| D9430 |
|
944 |
931 |
$29K |
| D1320 |
|
2,485 |
2,485 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
349 |
215 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
178 |
123 |
$10K |
| D0601 |
|
207 |
207 |
$3K |