| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
29,926 |
29,903 |
$1.77M |
| D0120 |
Periodic oral evaluation - established patient |
31,801 |
31,777 |
$1.27M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,622 |
5,840 |
$1.11M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,659 |
1,895 |
$677K |
| D1206 |
Topical application of fluoride varnish |
16,093 |
16,062 |
$663K |
| D1351 |
Sealant - per tooth |
5,902 |
3,699 |
$649K |
| D0272 |
Bitewings - two radiographic images |
22,904 |
22,856 |
$537K |
| D1110 |
Prophylaxis - adult |
6,582 |
6,579 |
$522K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,055 |
3,685 |
$412K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,234 |
19,220 |
$371K |
| D0220 |
Intraoral - periapical first radiographic image |
15,984 |
15,862 |
$310K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,753 |
2,403 |
$238K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
929 |
861 |
$150K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,972 |
11,923 |
$138K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,903 |
2,899 |
$118K |
| D0274 |
Bitewings - four radiographic images |
2,915 |
2,914 |
$117K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
383 |
321 |
$117K |
| D9995 |
|
3,178 |
3,178 |
$72K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
302 |
273 |
$63K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,370 |
5,083 |
$39K |
| D9222 |
|
323 |
307 |
$32K |
| D1354 |
|
1,276 |
821 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,015 |
1,000 |
$20K |
| D0145 |
Oral evaluation for a patient under three years of age |
431 |
431 |
$18K |
| D2332 |
|
61 |
56 |
$14K |
| D2330 |
|
112 |
107 |
$13K |
| D0330 |
Panoramic radiographic image |
153 |
153 |
$8K |
| D0270 |
|
228 |
228 |
$4K |
| D1510 |
|
13 |
13 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
101 |
100 |
$1K |
| D9430 |
|
40 |
40 |
$1K |
| D0160 |
|
14 |
14 |
$568.40 |
| D0273 |
|
13 |
13 |
$260.00 |
| D1330 |
|
19,235 |
19,224 |
$84.00 |
| D1999 |
|
7,747 |
7,373 |
$0.00 |
| D0601 |
|
3,417 |
3,416 |
$0.00 |
| D0603 |
|
11,119 |
11,113 |
$0.00 |
| D0602 |
|
4,292 |
4,289 |
$0.00 |
| D1310 |
|
1,558 |
1,557 |
$0.00 |