| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
93,834 |
93,468 |
$5.30M |
| D1120 |
Prophylaxis - child |
113,098 |
112,691 |
$4.52M |
| D0350 |
|
363,482 |
111,948 |
$3.06M |
| D1208 |
Topical application of fluoride, excluding varnish |
111,739 |
111,331 |
$1.64M |
| D0230 |
Intraoral - periapical each additional radiographic image |
386,184 |
101,566 |
$1.55M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19,639 |
14,344 |
$1.29M |
| D1351 |
Sealant - per tooth |
40,576 |
11,050 |
$1.20M |
| D1310 |
|
20,915 |
20,768 |
$936K |
| D0274 |
Bitewings - four radiographic images |
44,486 |
44,291 |
$935K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,583 |
5,361 |
$884K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
22,346 |
21,275 |
$877K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,210 |
12,187 |
$794K |
| D0145 |
Oral evaluation for a patient under three years of age |
9,488 |
9,459 |
$603K |
| D7140 |
Extraction, erupted tooth or exposed root |
10,024 |
7,192 |
$562K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,216 |
6,840 |
$438K |
| D0272 |
Bitewings - two radiographic images |
35,850 |
35,738 |
$419K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,220 |
3,344 |
$413K |
| D0330 |
Panoramic radiographic image |
11,853 |
11,781 |
$344K |
| D0220 |
Intraoral - periapical first radiographic image |
29,162 |
28,649 |
$340K |
| D0603 |
|
13,859 |
13,775 |
$205K |
| D9430 |
|
5,724 |
5,559 |
$182K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
772 |
420 |
$147K |
| D0602 |
|
6,652 |
6,607 |
$94K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,137 |
1,060 |
$89K |
| D9222 |
|
419 |
419 |
$51K |
| D2940 |
|
612 |
524 |
$14K |
| D2330 |
|
137 |
91 |
$11K |
| D2332 |
|
35 |
27 |
$3K |
| D1515 |
|
14 |
14 |
$3K |
| D1510 |
|
15 |
12 |
$2K |
| D0601 |
|
117 |
117 |
$2K |
| D1206 |
Topical application of fluoride varnish |
153 |
152 |
$1K |
| D0270 |
|
217 |
217 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
837 |
836 |
$0.00 |