| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
21,445 |
21,395 |
$1.15M |
| D1120 |
Prophylaxis - child |
19,811 |
19,758 |
$750K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,169 |
5,841 |
$739K |
| D0230 |
Intraoral - periapical each additional radiographic image |
127,700 |
26,626 |
$526K |
| D1110 |
Prophylaxis - adult |
5,483 |
5,472 |
$461K |
| D4260 |
|
677 |
179 |
$332K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,472 |
2,912 |
$312K |
| D1351 |
Sealant - per tooth |
11,061 |
3,057 |
$295K |
| D0210 |
Intraoral - complete series of radiographic images |
6,089 |
6,069 |
$281K |
| D2740 |
Crown - porcelain/ceramic |
555 |
413 |
$263K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,122 |
4,113 |
$256K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,101 |
20,047 |
$240K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,021 |
2,121 |
$237K |
| D4341 |
|
2,950 |
793 |
$200K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,834 |
1,428 |
$189K |
| D0274 |
Bitewings - four radiographic images |
7,728 |
7,706 |
$163K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,027 |
1,575 |
$161K |
| D0220 |
Intraoral - periapical first radiographic image |
11,941 |
11,546 |
$141K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
295 |
268 |
$135K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,368 |
905 |
$135K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,097 |
532 |
$129K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,088 |
789 |
$128K |
| D7240 |
Removal of impacted tooth - completely bony |
474 |
202 |
$109K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,595 |
2,493 |
$104K |
| D0272 |
Bitewings - two radiographic images |
7,475 |
7,458 |
$87K |
| D7230 |
|
365 |
194 |
$69K |
| D2160 |
|
800 |
579 |
$64K |
| D9430 |
|
1,414 |
1,398 |
$45K |
| D2332 |
|
335 |
215 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,206 |
1,206 |
$27K |
| D2330 |
|
256 |
159 |
$19K |
| D4342 |
|
336 |
100 |
$14K |
| D2954 |
|
79 |
62 |
$8K |
| D2140 |
|
131 |
73 |
$7K |
| D2335 |
|
45 |
33 |
$5K |
| D0330 |
Panoramic radiographic image |
150 |
150 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$826.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
47 |
47 |
$6.48 |