| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
75,342 |
75,110 |
$4.18M |
| D1120 |
Prophylaxis - child |
92,812 |
92,409 |
$3.69M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
17,482 |
8,863 |
$2.04M |
| D1310 |
|
32,641 |
32,525 |
$1.49M |
| D1208 |
Topical application of fluoride, excluding varnish |
92,313 |
91,898 |
$1.39M |
| D0230 |
Intraoral - periapical each additional radiographic image |
318,355 |
76,722 |
$1.32M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
12,618 |
6,681 |
$1.24M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16,583 |
11,811 |
$1.10M |
| D9993 |
|
14,079 |
14,077 |
$910K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,691 |
10,659 |
$699K |
| D7140 |
Extraction, erupted tooth or exposed root |
11,656 |
7,198 |
$655K |
| D2140 |
|
9,744 |
6,945 |
$527K |
| D0274 |
Bitewings - four radiographic images |
21,919 |
21,833 |
$463K |
| D0145 |
Oral evaluation for a patient under three years of age |
7,319 |
7,296 |
$459K |
| D1351 |
Sealant - per tooth |
14,629 |
4,372 |
$453K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,364 |
10,200 |
$410K |
| D0603 |
|
27,131 |
27,040 |
$404K |
| D0272 |
Bitewings - two radiographic images |
32,456 |
32,336 |
$378K |
| D0220 |
Intraoral - periapical first radiographic image |
25,746 |
25,589 |
$300K |
| D2160 |
|
3,731 |
3,185 |
$293K |
| D0350 |
|
19,360 |
12,804 |
$191K |
| D2330 |
|
2,183 |
1,448 |
$167K |
| D0602 |
|
4,685 |
4,671 |
$70K |
| D9430 |
|
1,248 |
1,242 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
419 |
266 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
251 |
167 |
$13K |
| D1320 |
|
849 |
849 |
$8K |
| D1510 |
|
28 |
25 |
$4K |
| D1354 |
|
230 |
72 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
50 |
50 |
$2K |
| D1206 |
Topical application of fluoride varnish |
183 |
183 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
15 |
$1K |
| D2332 |
|
14 |
12 |
$1K |
| D7111 |
|
13 |
12 |
$746.20 |
| D9248 |
|
14 |
14 |
$490.00 |
| D0601 |
|
14 |
14 |
$210.00 |