| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
35,827 |
35,670 |
$1.94M |
| D1120 |
Prophylaxis - child |
46,173 |
45,927 |
$1.78M |
| D0230 |
Intraoral - periapical each additional radiographic image |
212,282 |
42,068 |
$854K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,719 |
7,595 |
$770K |
| D1208 |
Topical application of fluoride, excluding varnish |
44,317 |
44,095 |
$620K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15,532 |
14,677 |
$610K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,196 |
2,659 |
$599K |
| D1310 |
|
10,680 |
10,587 |
$472K |
| D1351 |
Sealant - per tooth |
17,703 |
5,577 |
$449K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,784 |
6,762 |
$422K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,269 |
1,943 |
$420K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,278 |
4,306 |
$333K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,973 |
3,125 |
$281K |
| D0272 |
Bitewings - two radiographic images |
19,677 |
19,601 |
$228K |
| D9993 |
|
3,468 |
3,458 |
$207K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,310 |
3,289 |
$197K |
| D0274 |
Bitewings - four radiographic images |
8,530 |
8,471 |
$180K |
| D0220 |
Intraoral - periapical first radiographic image |
14,876 |
14,713 |
$170K |
| D9430 |
|
4,847 |
4,704 |
$151K |
| D8670 |
Periodic orthodontic treatment visit |
480 |
480 |
$141K |
| D0603 |
|
6,646 |
6,594 |
$94K |
| D0140 |
Limited oral evaluation - problem focused |
1,590 |
1,590 |
$56K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
703 |
361 |
$47K |
| D2330 |
|
626 |
365 |
$47K |
| D0602 |
|
3,086 |
3,052 |
$45K |
| D0330 |
Panoramic radiographic image |
1,448 |
1,448 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
431 |
377 |
$34K |
| D1206 |
Topical application of fluoride varnish |
866 |
836 |
$15K |
| D9920 |
|
106 |
100 |
$10K |
| D2160 |
|
98 |
72 |
$8K |
| D2140 |
|
138 |
109 |
$8K |
| D0350 |
|
672 |
422 |
$6K |
| D0270 |
|
123 |
122 |
$610.00 |
| D0601 |
|
44 |
44 |
$540.00 |