| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
74,128 |
73,863 |
$4.20M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
33,082 |
12,578 |
$3.87M |
| D1120 |
Prophylaxis - child |
92,540 |
92,135 |
$3.72M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
32,476 |
12,057 |
$3.18M |
| D1310 |
|
34,766 |
34,593 |
$1.58M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19,972 |
10,038 |
$1.32M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
32,900 |
32,347 |
$1.30M |
| D7140 |
Extraction, erupted tooth or exposed root |
22,560 |
13,065 |
$1.27M |
| D0230 |
Intraoral - periapical each additional radiographic image |
288,475 |
95,975 |
$1.17M |
| D1208 |
Topical application of fluoride, excluding varnish |
77,486 |
77,120 |
$1.15M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16,509 |
16,450 |
$1.07M |
| D9993 |
|
13,682 |
13,669 |
$879K |
| D1351 |
Sealant - per tooth |
27,713 |
9,050 |
$858K |
| D2140 |
|
10,656 |
6,539 |
$574K |
| D0272 |
Bitewings - two radiographic images |
46,959 |
46,774 |
$542K |
| D0145 |
Oral evaluation for a patient under three years of age |
8,103 |
8,069 |
$507K |
| D1510 |
|
2,858 |
2,379 |
$428K |
| D0220 |
Intraoral - periapical first radiographic image |
36,380 |
35,975 |
$427K |
| D8670 |
Periodic orthodontic treatment visit |
1,364 |
1,364 |
$386K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,659 |
3,195 |
$368K |
| D0603 |
|
24,309 |
24,193 |
$359K |
| D0274 |
Bitewings - four radiographic images |
15,985 |
15,927 |
$330K |
| D2330 |
|
3,757 |
2,372 |
$285K |
| D0350 |
|
26,582 |
15,670 |
$273K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,827 |
3,192 |
$256K |
| D1206 |
Topical application of fluoride varnish |
13,347 |
13,321 |
$220K |
| D9430 |
|
4,844 |
4,706 |
$151K |
| D0602 |
|
6,511 |
6,467 |
$97K |
| D0330 |
Panoramic radiographic image |
3,045 |
3,029 |
$82K |
| D0140 |
Limited oral evaluation - problem focused |
1,821 |
1,817 |
$63K |
| D0601 |
|
3,283 |
3,276 |
$49K |
| D0340 |
|
814 |
812 |
$41K |
| D2160 |
|
487 |
394 |
$38K |
| D2331 |
|
273 |
216 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
182 |
143 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
180 |
180 |
$8K |
| D0270 |
|
1,167 |
1,156 |
$6K |
| D1352 |
|
20 |
12 |
$731.50 |
| D9999 |
Unspecified adjunctive procedure, by report |
42 |
42 |
$141.84 |