| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
42,281 |
42,181 |
$2.42M |
| D1120 |
Prophylaxis - child |
54,792 |
54,678 |
$2.15M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16,199 |
8,989 |
$1.08M |
| D0230 |
Intraoral - periapical each additional radiographic image |
137,858 |
47,875 |
$1.03M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,555 |
3,681 |
$1.00M |
| D2140 |
|
15,132 |
8,859 |
$823K |
| D1351 |
Sealant - per tooth |
28,619 |
10,040 |
$797K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19,555 |
19,308 |
$770K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,423 |
3,154 |
$736K |
| D7140 |
Extraction, erupted tooth or exposed root |
12,716 |
7,765 |
$727K |
| D1310 |
|
14,279 |
14,244 |
$655K |
| D1208 |
Topical application of fluoride, excluding varnish |
46,975 |
46,887 |
$552K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,398 |
8,390 |
$535K |
| D9993 |
|
7,578 |
7,578 |
$492K |
| D0220 |
Intraoral - periapical first radiographic image |
20,699 |
20,612 |
$245K |
| D0210 |
Intraoral - complete series of radiographic images |
5,108 |
5,097 |
$241K |
| D0274 |
Bitewings - four radiographic images |
10,365 |
10,324 |
$224K |
| D0350 |
|
16,412 |
11,462 |
$216K |
| D0272 |
Bitewings - two radiographic images |
18,326 |
18,291 |
$215K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,436 |
3,431 |
$205K |
| D1206 |
Topical application of fluoride varnish |
7,301 |
7,277 |
$198K |
| D2330 |
|
2,036 |
1,235 |
$156K |
| D0603 |
|
10,114 |
10,086 |
$151K |
| D2160 |
|
1,062 |
796 |
$85K |
| D0602 |
|
2,978 |
2,971 |
$45K |
| D1320 |
|
3,681 |
3,681 |
$37K |
| D1510 |
|
188 |
171 |
$22K |
| D9430 |
|
371 |
371 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
153 |
94 |
$10K |
| D2331 |
|
56 |
42 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
28 |
$2K |
| D0270 |
|
285 |
285 |
$1K |
| D0601 |
|
29 |
29 |
$435.00 |