| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,106 |
4,093 |
$237K |
| D1120 |
Prophylaxis - child |
5,231 |
5,216 |
$213K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
853 |
305 |
$207K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,360 |
1,183 |
$154K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,144 |
1,141 |
$78K |
| D9420 |
|
908 |
645 |
$65K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
460 |
239 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,173 |
1,069 |
$45K |
| D1310 |
|
920 |
919 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,672 |
3,656 |
$40K |
| D9222 |
|
306 |
306 |
$37K |
| D1351 |
Sealant - per tooth |
1,015 |
325 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,376 |
1,375 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,459 |
3,549 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
603 |
390 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
560 |
311 |
$31K |
| D0272 |
Bitewings - two radiographic images |
2,062 |
2,056 |
$24K |
| D9430 |
|
677 |
658 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,453 |
1,409 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
129 |
81 |
$12K |
| D0603 |
|
800 |
800 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
126 |
126 |
$9K |
| D0274 |
Bitewings - four radiographic images |
355 |
355 |
$7K |
| D0350 |
|
737 |
490 |
$7K |
| D9993 |
|
85 |
85 |
$5K |
| D2330 |
|
19 |
12 |
$1K |
| D9248 |
|
12 |
12 |
$420.00 |
| D1999 |
|
13 |
13 |
$0.00 |