| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
53,897 |
53,702 |
$2.88M |
| D1120 |
Prophylaxis - child |
71,221 |
70,969 |
$2.75M |
| D0230 |
Intraoral - periapical each additional radiographic image |
310,716 |
67,775 |
$1.27M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17,983 |
9,871 |
$1.20M |
| D1351 |
Sealant - per tooth |
38,751 |
13,415 |
$1.11M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,826 |
3,751 |
$809K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,924 |
11,915 |
$778K |
| D1206 |
Topical application of fluoride varnish |
47,216 |
46,973 |
$751K |
| D7111 |
|
11,302 |
7,064 |
$647K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,452 |
14,143 |
$564K |
| D1310 |
|
11,551 |
11,488 |
$521K |
| D2140 |
|
8,947 |
5,557 |
$487K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,415 |
4,616 |
$458K |
| D0220 |
Intraoral - periapical first radiographic image |
35,919 |
35,404 |
$421K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,119 |
2,591 |
$407K |
| D0272 |
Bitewings - two radiographic images |
33,145 |
32,981 |
$392K |
| D9993 |
|
4,972 |
4,954 |
$317K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,643 |
2,774 |
$310K |
| D0350 |
|
23,998 |
14,045 |
$239K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,945 |
2,523 |
$225K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,458 |
3,444 |
$198K |
| D2160 |
|
2,303 |
1,561 |
$183K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,933 |
22,923 |
$182K |
| D2330 |
|
2,292 |
1,454 |
$176K |
| D0603 |
|
8,912 |
8,874 |
$106K |
| D0274 |
Bitewings - four radiographic images |
3,594 |
3,587 |
$77K |
| D0601 |
|
4,095 |
4,082 |
$51K |
| D9430 |
|
796 |
787 |
$25K |
| D1510 |
|
86 |
77 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
200 |
200 |
$10K |
| D0270 |
|
1,191 |
1,184 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
50 |
45 |
$4K |
| D9110 |
|
136 |
133 |
$2K |
| D0602 |
|
349 |
349 |
$885.00 |
| D1999 |
|
8,189 |
8,072 |
$125.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
48 |
48 |
$108.47 |
| D1330 |
|
37,191 |
37,144 |
$0.00 |
| D9920 |
|
15 |
15 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
45 |
45 |
$0.00 |