| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
118,852 |
118,492 |
$6.61M |
| D1120 |
Prophylaxis - child |
140,063 |
139,578 |
$5.52M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
28,252 |
11,707 |
$3.30M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
28,664 |
11,377 |
$2.80M |
| D1310 |
|
40,287 |
40,111 |
$1.83M |
| D1208 |
Topical application of fluoride, excluding varnish |
96,491 |
96,077 |
$1.55M |
| D7140 |
Extraction, erupted tooth or exposed root |
26,736 |
15,208 |
$1.51M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
37,005 |
36,446 |
$1.45M |
| D0230 |
Intraoral - periapical each additional radiographic image |
354,479 |
146,253 |
$1.45M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17,643 |
8,230 |
$1.17M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17,135 |
17,098 |
$1.11M |
| D9993 |
|
15,648 |
15,633 |
$1.01M |
| D0272 |
Bitewings - two radiographic images |
77,471 |
77,198 |
$894K |
| D0274 |
Bitewings - four radiographic images |
39,680 |
39,573 |
$829K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,008 |
6,082 |
$720K |
| D1351 |
Sealant - per tooth |
27,625 |
7,828 |
$720K |
| D0145 |
Oral evaluation for a patient under three years of age |
9,939 |
9,914 |
$621K |
| D1206 |
Topical application of fluoride varnish |
43,114 |
43,069 |
$442K |
| D0603 |
|
29,892 |
29,768 |
$441K |
| D0220 |
Intraoral - periapical first radiographic image |
34,021 |
33,734 |
$395K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,389 |
4,983 |
$392K |
| D2140 |
|
5,634 |
3,586 |
$304K |
| D0350 |
|
28,051 |
16,985 |
$283K |
| D1510 |
|
1,561 |
1,308 |
$214K |
| D9430 |
|
6,367 |
6,252 |
$199K |
| D8670 |
Periodic orthodontic treatment visit |
620 |
617 |
$175K |
| D0340 |
|
3,007 |
2,999 |
$149K |
| D2330 |
|
1,596 |
1,033 |
$121K |
| D0140 |
Limited oral evaluation - problem focused |
3,542 |
3,534 |
$120K |
| D0330 |
Panoramic radiographic image |
3,732 |
3,711 |
$107K |
| D2160 |
|
1,255 |
849 |
$99K |
| D0210 |
Intraoral - complete series of radiographic images |
1,734 |
1,734 |
$81K |
| D0601 |
|
5,332 |
5,314 |
$79K |
| D7240 |
Removal of impacted tooth - completely bony |
329 |
137 |
$76K |
| D0602 |
|
3,683 |
3,662 |
$54K |
| D0270 |
|
2,662 |
2,647 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
126 |
95 |
$10K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
12 |
12 |
$7K |
| D2331 |
|
22 |
15 |
$2K |
| D9310 |
|
36 |
36 |
$2K |
| D9222 |
|
12 |
12 |
$1K |
| D9610 |
|
12 |
12 |
$1K |
| D8660 |
|
25 |
25 |
$0.00 |