| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
24,718 |
24,678 |
$1.34M |
| D1120 |
Prophylaxis - child |
28,803 |
28,729 |
$1.09M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
9,814 |
4,833 |
$657K |
| D0230 |
Intraoral - periapical each additional radiographic image |
150,888 |
29,113 |
$636K |
| D1351 |
Sealant - per tooth |
21,748 |
7,747 |
$607K |
| D2140 |
|
7,721 |
4,431 |
$419K |
| D1208 |
Topical application of fluoride, excluding varnish |
29,177 |
29,100 |
$374K |
| D0274 |
Bitewings - four radiographic images |
12,149 |
12,128 |
$259K |
| D1310 |
|
5,468 |
5,458 |
$249K |
| D9993 |
|
3,060 |
3,059 |
$196K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,857 |
2,846 |
$180K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,737 |
1,708 |
$157K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,261 |
675 |
$148K |
| D0220 |
Intraoral - periapical first radiographic image |
10,003 |
9,950 |
$118K |
| D0272 |
Bitewings - two radiographic images |
7,446 |
7,432 |
$88K |
| D0350 |
|
8,453 |
5,504 |
$86K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
682 |
357 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,003 |
669 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,097 |
1,077 |
$42K |
| D0603 |
|
2,805 |
2,802 |
$41K |
| D2160 |
|
468 |
337 |
$37K |
| D0145 |
Oral evaluation for a patient under three years of age |
457 |
457 |
$27K |
| D0602 |
|
655 |
655 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
95 |
95 |
$4K |
| D0601 |
|
225 |
225 |
$3K |
| D2330 |
|
27 |
17 |
$2K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$216.00 |