| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
25,952 |
25,832 |
$1.38M |
| D1120 |
Prophylaxis - child |
31,902 |
31,748 |
$1.19M |
| D1206 |
Topical application of fluoride varnish |
32,677 |
32,447 |
$434K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,336 |
4,531 |
$421K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,386 |
1,779 |
$396K |
| D0230 |
Intraoral - periapical each additional radiographic image |
100,496 |
25,668 |
$387K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,779 |
6,499 |
$263K |
| D0274 |
Bitewings - four radiographic images |
11,566 |
11,531 |
$229K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,163 |
3,147 |
$190K |
| D1351 |
Sealant - per tooth |
6,224 |
2,510 |
$185K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,343 |
2,483 |
$180K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,950 |
1,868 |
$168K |
| D1310 |
|
4,533 |
4,521 |
$148K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,133 |
2,127 |
$139K |
| D0272 |
Bitewings - two radiographic images |
8,638 |
8,581 |
$97K |
| D0220 |
Intraoral - periapical first radiographic image |
6,434 |
6,354 |
$74K |
| D0350 |
|
7,728 |
4,918 |
$72K |
| D0330 |
Panoramic radiographic image |
1,898 |
1,890 |
$55K |
| D0270 |
|
9,069 |
8,981 |
$45K |
| D1352 |
|
1,664 |
926 |
$45K |
| D0603 |
|
3,398 |
3,388 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
371 |
370 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
188 |
164 |
$15K |
| D9430 |
|
355 |
349 |
$11K |
| D1354 |
|
628 |
191 |
$7K |
| D0601 |
|
571 |
570 |
$7K |
| D2330 |
|
75 |
52 |
$6K |
| D0602 |
|
88 |
88 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
25 |
25 |
$2.44 |
| D1330 |
|
151 |
150 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
121 |
84 |
$0.00 |
| D9996 |
|
943 |
941 |
$0.00 |