| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
24,020 |
23,979 |
$1.43M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,524 |
4,694 |
$1.36M |
| D1120 |
Prophylaxis - child |
33,113 |
33,030 |
$1.29M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
12,489 |
5,202 |
$1.23M |
| D1351 |
Sealant - per tooth |
34,303 |
9,172 |
$947K |
| D7140 |
Extraction, erupted tooth or exposed root |
13,356 |
8,046 |
$764K |
| D0230 |
Intraoral - periapical each additional radiographic image |
71,897 |
32,392 |
$694K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
10,303 |
5,688 |
$689K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15,670 |
14,612 |
$619K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,166 |
8,150 |
$499K |
| D2140 |
|
8,910 |
5,601 |
$485K |
| D1208 |
Topical application of fluoride, excluding varnish |
33,429 |
33,342 |
$460K |
| D1510 |
|
2,980 |
2,511 |
$459K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,953 |
3,664 |
$323K |
| D0272 |
Bitewings - two radiographic images |
25,651 |
25,593 |
$304K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,079 |
3,072 |
$183K |
| D2160 |
|
2,147 |
1,530 |
$171K |
| D0350 |
|
10,711 |
7,743 |
$134K |
| D2330 |
|
1,590 |
1,101 |
$121K |
| D0220 |
Intraoral - periapical first radiographic image |
8,959 |
8,828 |
$106K |
| D9430 |
|
720 |
714 |
$23K |
| D2331 |
|
134 |
87 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
141 |
138 |
$6K |
| D0270 |
|
445 |
445 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
13 |
$2K |
| D1110 |
Prophylaxis - adult |
16 |
16 |
$1K |