| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
37,079 |
36,929 |
$1.70M |
| D0120 |
Periodic oral evaluation - established patient |
23,914 |
23,818 |
$1.57M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,926 |
4,990 |
$1.40M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
12,133 |
4,872 |
$1.18M |
| D1310 |
|
22,708 |
22,619 |
$1.02M |
| D1208 |
Topical application of fluoride, excluding varnish |
33,086 |
32,938 |
$659K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,276 |
9,240 |
$622K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,825 |
13,330 |
$549K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,794 |
4,182 |
$511K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,994 |
4,997 |
$500K |
| D0230 |
Intraoral - periapical each additional radiographic image |
113,594 |
32,095 |
$464K |
| D9993 |
|
5,559 |
5,557 |
$353K |
| D1351 |
Sealant - per tooth |
10,439 |
3,765 |
$328K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,054 |
3,686 |
$318K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,797 |
3,784 |
$257K |
| D0603 |
|
16,778 |
16,714 |
$245K |
| D0272 |
Bitewings - two radiographic images |
20,903 |
20,801 |
$241K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,281 |
1,692 |
$215K |
| D2330 |
|
2,150 |
1,313 |
$163K |
| D8670 |
Periodic orthodontic treatment visit |
450 |
450 |
$132K |
| D0350 |
|
12,789 |
6,972 |
$129K |
| D0220 |
Intraoral - periapical first radiographic image |
7,199 |
7,142 |
$85K |
| D0602 |
|
4,378 |
4,362 |
$65K |
| D2140 |
|
1,183 |
691 |
$63K |
| D0274 |
Bitewings - four radiographic images |
2,982 |
2,967 |
$63K |
| D0340 |
|
1,077 |
1,059 |
$54K |
| D1206 |
Topical application of fluoride varnish |
3,196 |
3,194 |
$48K |
| D9430 |
|
1,376 |
1,335 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,169 |
1,148 |
$40K |
| D0330 |
Panoramic radiographic image |
1,343 |
1,307 |
$38K |
| D1510 |
|
51 |
38 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
75 |
70 |
$6K |
| D0270 |
|
268 |
268 |
$1K |
| D9920 |
|
29 |
29 |
$0.00 |