| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
82,560 |
82,341 |
$4.64M |
| D1120 |
Prophylaxis - child |
84,638 |
84,382 |
$3.26M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
44,231 |
27,011 |
$2.94M |
| D0230 |
Intraoral - periapical each additional radiographic image |
505,380 |
92,782 |
$2.08M |
| D8670 |
Periodic orthodontic treatment visit |
5,852 |
5,832 |
$1.68M |
| D2140 |
|
23,317 |
17,180 |
$1.26M |
| D2160 |
|
14,383 |
10,628 |
$1.14M |
| D1208 |
Topical application of fluoride, excluding varnish |
81,947 |
81,703 |
$961K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14,390 |
14,323 |
$920K |
| D7140 |
Extraction, erupted tooth or exposed root |
12,683 |
8,543 |
$719K |
| D0274 |
Bitewings - four radiographic images |
30,916 |
30,818 |
$649K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,336 |
1,013 |
$635K |
| D1310 |
|
13,461 |
13,427 |
$608K |
| D0272 |
Bitewings - two radiographic images |
49,419 |
49,274 |
$576K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,166 |
2,325 |
$488K |
| D0350 |
|
48,572 |
30,117 |
$476K |
| D1351 |
Sealant - per tooth |
14,982 |
5,081 |
$463K |
| D9993 |
|
7,431 |
7,420 |
$408K |
| D4341 |
|
5,811 |
2,132 |
$396K |
| D0210 |
Intraoral - complete series of radiographic images |
7,763 |
7,696 |
$360K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,201 |
1,882 |
$316K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,290 |
1,511 |
$272K |
| D2330 |
|
3,463 |
2,318 |
$265K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,978 |
2,970 |
$188K |
| D1110 |
Prophylaxis - adult |
2,034 |
2,029 |
$174K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
332 |
318 |
$153K |
| D0140 |
Limited oral evaluation - problem focused |
3,692 |
3,688 |
$128K |
| D9430 |
|
3,745 |
3,711 |
$118K |
| D4342 |
|
1,803 |
793 |
$74K |
| D0601 |
|
4,721 |
4,710 |
$70K |
| D2954 |
|
627 |
537 |
$65K |
| D4910 |
|
808 |
806 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
912 |
601 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
5,125 |
5,089 |
$59K |
| D0603 |
|
3,711 |
3,699 |
$54K |
| D0602 |
|
3,573 |
3,561 |
$53K |
| D2335 |
|
372 |
211 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
806 |
559 |
$43K |
| D2332 |
|
410 |
307 |
$34K |
| D7230 |
|
133 |
85 |
$25K |
| D2161 |
|
269 |
243 |
$23K |
| D0330 |
Panoramic radiographic image |
2,098 |
2,089 |
$21K |
| D3320 |
|
57 |
53 |
$21K |
| D1510 |
|
106 |
101 |
$20K |
| D8680 |
|
48 |
24 |
$14K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
12 |
12 |
$13K |
| D7240 |
Removal of impacted tooth - completely bony |
50 |
30 |
$12K |
| D7250 |
|
17 |
13 |
$2K |
| D0270 |
|
282 |
279 |
$1K |
| D0340 |
|
12 |
12 |
$600.00 |
| D1352 |
|
14 |
12 |
$308.00 |