| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
28,989 |
28,911 |
$1.67M |
| D1120 |
Prophylaxis - child |
35,139 |
35,046 |
$1.42M |
| D0350 |
|
94,013 |
29,465 |
$800K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,724 |
5,936 |
$569K |
| D1351 |
Sealant - per tooth |
18,903 |
5,599 |
$561K |
| D0230 |
Intraoral - periapical each additional radiographic image |
120,443 |
32,036 |
$488K |
| D1208 |
Topical application of fluoride, excluding varnish |
33,359 |
33,272 |
$474K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,022 |
2,877 |
$466K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,225 |
8,630 |
$361K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,368 |
2,435 |
$327K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,700 |
4,695 |
$298K |
| D0274 |
Bitewings - four radiographic images |
13,344 |
13,309 |
$280K |
| D1310 |
|
5,356 |
5,325 |
$226K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,056 |
2,073 |
$171K |
| D0272 |
Bitewings - two radiographic images |
12,690 |
12,655 |
$149K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,800 |
2,112 |
$147K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,091 |
2,091 |
$129K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,282 |
1,001 |
$100K |
| D0220 |
Intraoral - periapical first radiographic image |
7,031 |
6,938 |
$82K |
| D9430 |
|
1,902 |
1,853 |
$60K |
| D0330 |
Panoramic radiographic image |
2,097 |
2,096 |
$60K |
| D1510 |
|
240 |
196 |
$46K |
| D2335 |
|
393 |
227 |
$45K |
| D0603 |
|
2,568 |
2,558 |
$37K |
| D0601 |
|
1,628 |
1,627 |
$21K |
| D2330 |
|
153 |
76 |
$12K |
| D2940 |
|
480 |
310 |
$7K |
| D2332 |
|
82 |
45 |
$6K |
| D0602 |
|
460 |
459 |
$6K |
| D2394 |
|
39 |
35 |
$3K |
| D0270 |
|
165 |
164 |
$820.00 |
| D9996 |
|
87 |
87 |
$0.00 |