| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12,058 |
11,966 |
$882K |
| D1120 |
Prophylaxis - child |
17,859 |
17,728 |
$858K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,471 |
17,335 |
$324K |
| D1310 |
|
6,843 |
6,775 |
$297K |
| D0350 |
|
31,895 |
10,508 |
$281K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,258 |
1,193 |
$267K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,921 |
3,894 |
$264K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,015 |
2,953 |
$263K |
| D0230 |
Intraoral - periapical each additional radiographic image |
51,131 |
14,749 |
$207K |
| D1351 |
Sealant - per tooth |
5,432 |
1,506 |
$201K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,229 |
3,891 |
$168K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,705 |
1,835 |
$152K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,806 |
2,133 |
$149K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,909 |
1,902 |
$136K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,124 |
735 |
$110K |
| D0274 |
Bitewings - four radiographic images |
4,910 |
4,874 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
6,350 |
6,225 |
$75K |
| D0603 |
|
3,835 |
3,801 |
$55K |
| D9430 |
|
1,706 |
1,664 |
$55K |
| D0272 |
Bitewings - two radiographic images |
4,216 |
4,193 |
$49K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
68 |
40 |
$18K |
| D0602 |
|
1,215 |
1,208 |
$17K |
| D0601 |
|
1,154 |
1,145 |
$16K |
| D0330 |
Panoramic radiographic image |
536 |
532 |
$15K |
| D9222 |
|
40 |
40 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
58 |
50 |
$5K |