| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12,198 |
12,149 |
$685K |
| D1120 |
Prophylaxis - child |
11,721 |
11,676 |
$449K |
| D0230 |
Intraoral - periapical each additional radiographic image |
79,513 |
14,914 |
$327K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,775 |
2,468 |
$315K |
| D0274 |
Bitewings - four radiographic images |
8,315 |
8,266 |
$176K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,449 |
2,445 |
$150K |
| D1110 |
Prophylaxis - adult |
1,644 |
1,629 |
$142K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,283 |
12,224 |
$138K |
| D8670 |
Periodic orthodontic treatment visit |
423 |
423 |
$123K |
| D1351 |
Sealant - per tooth |
3,753 |
1,245 |
$100K |
| D2140 |
|
1,157 |
746 |
$61K |
| D4910 |
|
775 |
769 |
$59K |
| D2160 |
|
734 |
508 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
1,212 |
1,208 |
$57K |
| D1310 |
|
1,230 |
1,229 |
$56K |
| D0272 |
Bitewings - two radiographic images |
4,543 |
4,537 |
$50K |
| D9993 |
|
797 |
797 |
$50K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
358 |
229 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
3,448 |
3,388 |
$41K |
| D0350 |
|
4,261 |
2,299 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
525 |
289 |
$35K |
| D4341 |
|
373 |
101 |
$26K |
| D2330 |
|
333 |
214 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
426 |
278 |
$23K |
| D1206 |
Topical application of fluoride varnish |
1,159 |
1,157 |
$22K |
| D7111 |
|
369 |
227 |
$21K |
| D9430 |
|
361 |
355 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
111 |
45 |
$10K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
20 |
13 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
68 |
29 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
145 |
145 |
$7K |
| D0603 |
|
343 |
342 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
159 |
158 |
$5K |
| D0330 |
Panoramic radiographic image |
160 |
159 |
$4K |
| D2954 |
|
37 |
24 |
$4K |
| D0601 |
|
141 |
141 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
43 |
40 |
$2K |
| D2332 |
|
20 |
13 |
$1K |