| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
37,844 |
37,685 |
$1.62M |
| D0120 |
Periodic oral evaluation - established patient |
26,421 |
26,282 |
$1.62M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,132 |
9,756 |
$872K |
| D1310 |
|
16,358 |
16,281 |
$744K |
| D7140 |
Extraction, erupted tooth or exposed root |
12,422 |
7,579 |
$706K |
| D1208 |
Topical application of fluoride, excluding varnish |
37,837 |
37,664 |
$636K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,279 |
7,266 |
$475K |
| D0230 |
Intraoral - periapical each additional radiographic image |
107,647 |
31,905 |
$437K |
| D9993 |
|
5,852 |
5,851 |
$351K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,880 |
5,697 |
$232K |
| D0220 |
Intraoral - periapical first radiographic image |
16,910 |
16,713 |
$201K |
| D0603 |
|
13,452 |
13,386 |
$199K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,639 |
2,851 |
$193K |
| D0274 |
Bitewings - four radiographic images |
8,923 |
8,899 |
$188K |
| D0350 |
|
14,901 |
8,980 |
$144K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,116 |
802 |
$132K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,913 |
1,908 |
$125K |
| D1351 |
Sealant - per tooth |
3,187 |
1,310 |
$96K |
| D0272 |
Bitewings - two radiographic images |
7,793 |
7,761 |
$91K |
| D9430 |
|
2,760 |
2,709 |
$86K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
560 |
506 |
$44K |
| D0602 |
|
1,261 |
1,254 |
$19K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
146 |
116 |
$15K |
| D2932 |
|
77 |
28 |
$8K |
| D2330 |
|
96 |
74 |
$7K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
49 |
14 |
$6K |
| D0330 |
Panoramic radiographic image |
177 |
177 |
$5K |
| D9222 |
|
14 |
14 |
$2K |
| D9610 |
|
45 |
14 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$624.00 |
| D0601 |
|
20 |
20 |
$300.00 |