| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
41,080 |
41,057 |
$2.31M |
| D0120 |
Periodic oral evaluation - established patient |
44,269 |
44,252 |
$1.71M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,095 |
7,972 |
$1.46M |
| D1351 |
Sealant - per tooth |
14,152 |
6,507 |
$1.04M |
| D1110 |
Prophylaxis - adult |
10,362 |
10,356 |
$771K |
| D1208 |
Topical application of fluoride, excluding varnish |
31,931 |
31,915 |
$743K |
| D0272 |
Bitewings - two radiographic images |
31,543 |
31,524 |
$688K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,963 |
2,098 |
$674K |
| D1206 |
Topical application of fluoride varnish |
17,864 |
17,845 |
$655K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,352 |
4,269 |
$476K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,631 |
2,792 |
$293K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,697 |
6,688 |
$257K |
| D0220 |
Intraoral - periapical first radiographic image |
12,126 |
12,086 |
$214K |
| D0274 |
Bitewings - four radiographic images |
5,023 |
5,021 |
$178K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,221 |
1,067 |
$177K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,073 |
864 |
$152K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
328 |
314 |
$109K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,635 |
7,445 |
$95K |
| D2332 |
|
379 |
295 |
$67K |
| D0330 |
Panoramic radiographic image |
704 |
704 |
$33K |
| D2330 |
|
275 |
217 |
$29K |
| D9222 |
|
298 |
298 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,407 |
1,405 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,310 |
2,136 |
$26K |
| D2335 |
|
92 |
65 |
$24K |
| D1354 |
|
115 |
51 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
207 |
207 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
166 |
166 |
$6K |
| D9995 |
|
46 |
46 |
$563.52 |
| D0270 |
|
28 |
28 |
$480.90 |
| D1999 |
|
10,843 |
10,234 |
$150.00 |
| D0603 |
|
12,985 |
12,963 |
$50.00 |
| D1330 |
|
23,839 |
23,809 |
$25.00 |
| D0602 |
|
7,529 |
7,526 |
$0.00 |
| D0601 |
|
1,199 |
1,196 |
$0.00 |
| D1310 |
|
945 |
945 |
$0.00 |
| D9986 |
|
134 |
134 |
$0.00 |