| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,832 |
7,799 |
$498K |
| D1120 |
Prophylaxis - child |
11,872 |
11,825 |
$494K |
| D1310 |
|
11,725 |
11,678 |
$342K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,787 |
1,081 |
$328K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,860 |
1,037 |
$279K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,496 |
11,449 |
$212K |
| D0230 |
Intraoral - periapical each additional radiographic image |
44,907 |
10,657 |
$181K |
| D9993 |
|
11,730 |
11,683 |
$180K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,745 |
1,237 |
$179K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,519 |
2,512 |
$169K |
| D9920 |
|
1,172 |
1,147 |
$160K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,847 |
1,840 |
$125K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
432 |
140 |
$95K |
| D0272 |
Bitewings - two radiographic images |
7,222 |
7,190 |
$84K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
952 |
526 |
$76K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,733 |
1,678 |
$70K |
| D0603 |
|
7,452 |
7,418 |
$70K |
| D0350 |
|
7,352 |
2,762 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,270 |
677 |
$69K |
| D1351 |
Sealant - per tooth |
1,695 |
525 |
$52K |
| D0602 |
|
4,297 |
4,283 |
$46K |
| D9248 |
|
643 |
630 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,115 |
1,111 |
$23K |
| D9222 |
|
140 |
140 |
$17K |
| D2330 |
|
210 |
119 |
$16K |
| D9610 |
|
469 |
141 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
960 |
937 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
106 |
45 |
$7K |
| D1999 |
|
7,375 |
7,327 |
$7K |
| D9430 |
|
113 |
112 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
62 |
39 |
$3K |
| D9110 |
|
27 |
27 |
$2K |
| D1354 |
|
51 |
15 |
$612.00 |
| D1330 |
|
11,676 |
11,630 |
$0.00 |