| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
23,697 |
23,616 |
$1.39M |
| D1120 |
Prophylaxis - child |
30,071 |
29,912 |
$1.25M |
| D7240 |
Removal of impacted tooth - completely bony |
3,976 |
1,330 |
$911K |
| D0230 |
Intraoral - periapical each additional radiographic image |
129,598 |
27,139 |
$530K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,590 |
12,033 |
$492K |
| D1310 |
|
10,268 |
10,240 |
$468K |
| D1208 |
Topical application of fluoride, excluding varnish |
29,278 |
29,120 |
$455K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,939 |
4,239 |
$452K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,429 |
4,423 |
$286K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,171 |
3,177 |
$271K |
| D1351 |
Sealant - per tooth |
9,131 |
3,051 |
$264K |
| D0272 |
Bitewings - two radiographic images |
18,894 |
18,798 |
$217K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,624 |
2,239 |
$202K |
| D9993 |
|
3,049 |
3,043 |
$196K |
| D7230 |
|
757 |
378 |
$140K |
| D0603 |
|
7,354 |
7,336 |
$109K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,612 |
1,603 |
$106K |
| D9430 |
|
3,095 |
3,048 |
$97K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
673 |
421 |
$77K |
| D0274 |
Bitewings - four radiographic images |
3,485 |
3,479 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
5,751 |
5,680 |
$67K |
| D0350 |
|
4,940 |
2,809 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,164 |
1,164 |
$41K |
| D0330 |
Panoramic radiographic image |
976 |
976 |
$29K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
434 |
212 |
$29K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
291 |
124 |
$26K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
216 |
118 |
$25K |
| D0602 |
|
1,095 |
1,095 |
$16K |
| D8670 |
Periodic orthodontic treatment visit |
40 |
40 |
$12K |
| D2330 |
|
128 |
71 |
$9K |
| D0601 |
|
288 |
288 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
51 |
41 |
$4K |
| D1206 |
Topical application of fluoride varnish |
78 |
78 |
$881.00 |
| D2140 |
|
17 |
12 |
$779.00 |
| D1352 |
|
15 |
12 |
$343.40 |