| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
20,705 |
20,643 |
$1.15M |
| D1120 |
Prophylaxis - child |
24,671 |
24,585 |
$965K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
10,754 |
6,059 |
$722K |
| D0230 |
Intraoral - periapical each additional radiographic image |
149,255 |
22,658 |
$628K |
| D2140 |
|
6,410 |
4,213 |
$349K |
| D1351 |
Sealant - per tooth |
11,452 |
4,499 |
$327K |
| D1208 |
Topical application of fluoride, excluding varnish |
24,788 |
24,696 |
$321K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,777 |
6,484 |
$267K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,931 |
1,097 |
$227K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,804 |
2,352 |
$218K |
| D1310 |
|
4,386 |
4,359 |
$201K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,876 |
1,069 |
$185K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,754 |
2,744 |
$180K |
| D0274 |
Bitewings - four radiographic images |
7,752 |
7,723 |
$166K |
| D2160 |
|
2,072 |
1,509 |
$165K |
| D9993 |
|
1,941 |
1,941 |
$126K |
| D0350 |
|
11,664 |
6,599 |
$125K |
| D0272 |
Bitewings - two radiographic images |
10,183 |
10,156 |
$119K |
| D0220 |
Intraoral - periapical first radiographic image |
5,727 |
5,689 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
1,230 |
1,230 |
$55K |
| D0603 |
|
2,946 |
2,934 |
$44K |
| D0145 |
Oral evaluation for a patient under three years of age |
551 |
549 |
$31K |
| D2330 |
|
380 |
229 |
$29K |
| D0602 |
|
813 |
806 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
64 |
36 |
$4K |
| D9430 |
|
80 |
78 |
$3K |