| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
22,553 |
22,481 |
$1.25M |
| D1120 |
Prophylaxis - child |
30,048 |
29,923 |
$1.16M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,324 |
1,767 |
$509K |
| D1206 |
Topical application of fluoride varnish |
29,972 |
29,848 |
$421K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,857 |
25,545 |
$415K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,706 |
3,144 |
$380K |
| D1310 |
|
7,383 |
7,363 |
$333K |
| D7111 |
|
4,610 |
1,985 |
$263K |
| D1351 |
Sealant - per tooth |
9,152 |
3,716 |
$245K |
| D0274 |
Bitewings - four radiographic images |
11,220 |
11,175 |
$237K |
| D9993 |
|
3,602 |
3,601 |
$229K |
| D8670 |
Periodic orthodontic treatment visit |
722 |
720 |
$215K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,841 |
2,498 |
$205K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,954 |
2,947 |
$185K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,054 |
3,902 |
$158K |
| D9920 |
|
1,305 |
1,295 |
$141K |
| D9430 |
|
3,703 |
3,621 |
$117K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,677 |
1,053 |
$111K |
| D0272 |
Bitewings - two radiographic images |
9,104 |
9,071 |
$106K |
| D0350 |
|
6,605 |
6,211 |
$102K |
| D0603 |
|
5,054 |
5,045 |
$74K |
| D0140 |
Limited oral evaluation - problem focused |
1,219 |
1,218 |
$43K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
427 |
270 |
$42K |
| D2330 |
|
401 |
227 |
$30K |
| D0602 |
|
1,856 |
1,847 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,922 |
1,894 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
300 |
294 |
$15K |
| D9420 |
|
149 |
69 |
$12K |
| D1354 |
|
856 |
316 |
$10K |
| D2160 |
|
99 |
78 |
$8K |
| D1510 |
|
68 |
52 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
24 |
$2K |
| D2140 |
|
14 |
12 |
$655.20 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$576.00 |
| D0601 |
|
33 |
33 |
$495.00 |
| D0270 |
|
43 |
42 |
$215.00 |