| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
15,146 |
15,070 |
$762K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
10,815 |
6,394 |
$722K |
| D1120 |
Prophylaxis - child |
12,231 |
12,151 |
$477K |
| D0230 |
Intraoral - periapical each additional radiographic image |
85,595 |
16,993 |
$353K |
| D2160 |
|
3,693 |
2,816 |
$292K |
| D2140 |
|
4,369 |
3,198 |
$237K |
| D0274 |
Bitewings - four radiographic images |
11,177 |
11,139 |
$237K |
| D2330 |
|
3,132 |
1,852 |
$236K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,605 |
5,431 |
$219K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,891 |
1,822 |
$164K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,082 |
12,010 |
$160K |
| D1310 |
|
3,284 |
3,248 |
$149K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,190 |
2,182 |
$133K |
| D1110 |
Prophylaxis - adult |
1,533 |
1,532 |
$133K |
| D9993 |
|
1,813 |
1,806 |
$104K |
| D0350 |
|
7,359 |
4,867 |
$72K |
| D0272 |
Bitewings - two radiographic images |
4,774 |
4,738 |
$55K |
| D0603 |
|
2,561 |
2,528 |
$38K |
| D1351 |
Sealant - per tooth |
1,105 |
400 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
572 |
567 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,698 |
1,677 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
222 |
115 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
130 |
105 |
$13K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
17 |
15 |
$8K |
| D9430 |
|
238 |
234 |
$7K |
| D2161 |
|
66 |
66 |
$6K |
| D0602 |
|
195 |
195 |
$3K |
| D0601 |
|
29 |
29 |
$435.00 |