| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
49,116 |
48,964 |
$2.84M |
| D1120 |
Prophylaxis - child |
63,349 |
63,135 |
$2.51M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19,041 |
9,197 |
$1.27M |
| D0230 |
Intraoral - periapical each additional radiographic image |
235,819 |
51,192 |
$1.06M |
| D1351 |
Sealant - per tooth |
35,919 |
13,034 |
$1.03M |
| D1310 |
|
22,553 |
22,488 |
$1.02M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,370 |
3,187 |
$964K |
| D2140 |
|
16,267 |
8,858 |
$882K |
| D7140 |
Extraction, erupted tooth or exposed root |
14,820 |
8,582 |
$845K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,662 |
2,898 |
$743K |
| D9993 |
|
11,807 |
11,805 |
$724K |
| D1206 |
Topical application of fluoride varnish |
42,124 |
41,956 |
$697K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17,115 |
16,713 |
$670K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,008 |
7,981 |
$502K |
| D0145 |
Oral evaluation for a patient under three years of age |
6,613 |
6,597 |
$405K |
| D0220 |
Intraoral - periapical first radiographic image |
31,669 |
31,269 |
$376K |
| D0603 |
|
20,749 |
20,685 |
$307K |
| D0272 |
Bitewings - two radiographic images |
25,786 |
25,725 |
$306K |
| D0350 |
|
24,109 |
13,149 |
$282K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,424 |
21,382 |
$252K |
| D2330 |
|
2,529 |
1,561 |
$187K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,919 |
1,037 |
$129K |
| D2160 |
|
1,577 |
1,066 |
$125K |
| D0210 |
Intraoral - complete series of radiographic images |
1,777 |
1,774 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,172 |
604 |
$63K |
| D1510 |
|
143 |
129 |
$23K |
| D9430 |
|
720 |
709 |
$23K |
| D0601 |
|
1,001 |
1,001 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
79 |
52 |
$9K |
| D2331 |
|
59 |
44 |
$5K |
| D0602 |
|
79 |
79 |
$1K |