| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
19,267 |
19,173 |
$1.11M |
| D1120 |
Prophylaxis - child |
24,279 |
24,155 |
$969K |
| D1310 |
|
9,135 |
9,099 |
$410K |
| D0350 |
|
50,766 |
17,375 |
$399K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,579 |
23,462 |
$353K |
| D0230 |
Intraoral - periapical each additional radiographic image |
74,685 |
19,989 |
$315K |
| D9993 |
|
4,603 |
4,603 |
$294K |
| D1351 |
Sealant - per tooth |
8,887 |
2,406 |
$285K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,836 |
2,663 |
$253K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,956 |
844 |
$230K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,572 |
5,216 |
$219K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,597 |
2,587 |
$169K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,785 |
1,602 |
$156K |
| D0274 |
Bitewings - four radiographic images |
7,362 |
7,326 |
$148K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,222 |
603 |
$120K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,393 |
1,392 |
$88K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
204 |
151 |
$86K |
| D0603 |
|
5,825 |
5,809 |
$86K |
| D0220 |
Intraoral - periapical first radiographic image |
6,845 |
6,744 |
$80K |
| D0272 |
Bitewings - two radiographic images |
5,888 |
5,868 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
708 |
546 |
$37K |
| D9430 |
|
844 |
822 |
$27K |
| D0602 |
|
1,616 |
1,613 |
$24K |
| D0330 |
Panoramic radiographic image |
755 |
755 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
251 |
205 |
$20K |
| D9222 |
|
150 |
150 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
145 |
145 |
$7K |
| D0601 |
|
265 |
264 |
$4K |
| D2940 |
|
51 |
39 |
$2K |
| D0270 |
|
238 |
238 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
26 |
26 |
$0.00 |
| D9996 |
|
76 |
76 |
$0.00 |