| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
44,827 |
44,609 |
$2.53M |
| D1120 |
Prophylaxis - child |
48,999 |
48,759 |
$1.96M |
| D0230 |
Intraoral - periapical each additional radiographic image |
287,647 |
51,656 |
$1.15M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15,723 |
8,646 |
$1.05M |
| D1351 |
Sealant - per tooth |
27,447 |
9,771 |
$811K |
| D1208 |
Topical application of fluoride, excluding varnish |
53,096 |
52,834 |
$699K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15,092 |
14,650 |
$595K |
| D0274 |
Bitewings - four radiographic images |
25,403 |
25,273 |
$540K |
| D1310 |
|
11,959 |
11,903 |
$539K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,430 |
4,752 |
$481K |
| D1110 |
Prophylaxis - adult |
3,999 |
3,981 |
$344K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,530 |
5,507 |
$341K |
| D9993 |
|
5,167 |
5,165 |
$325K |
| D2140 |
|
4,931 |
3,361 |
$265K |
| D0272 |
Bitewings - two radiographic images |
19,783 |
19,705 |
$232K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,093 |
1,992 |
$167K |
| D0350 |
|
17,661 |
10,178 |
$166K |
| D7240 |
Removal of impacted tooth - completely bony |
566 |
209 |
$131K |
| D0603 |
|
8,357 |
8,304 |
$123K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
988 |
563 |
$117K |
| D0220 |
Intraoral - periapical first radiographic image |
9,116 |
8,923 |
$108K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,060 |
570 |
$105K |
| D2160 |
|
1,072 |
826 |
$85K |
| D7230 |
|
319 |
161 |
$60K |
| D2330 |
|
772 |
501 |
$59K |
| D0330 |
Panoramic radiographic image |
1,755 |
1,735 |
$52K |
| D0145 |
Oral evaluation for a patient under three years of age |
899 |
899 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
672 |
467 |
$45K |
| D4910 |
|
509 |
509 |
$39K |
| D9430 |
|
1,133 |
1,123 |
$36K |
| D2740 |
Crown - porcelain/ceramic |
69 |
59 |
$33K |
| D0602 |
|
1,353 |
1,349 |
$19K |
| D4341 |
|
251 |
68 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
39 |
26 |
$5K |
| D2954 |
|
28 |
24 |
$3K |
| D0601 |
|
157 |
157 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$945.00 |