| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
59,039 |
58,843 |
$3.28M |
| D1120 |
Prophylaxis - child |
72,375 |
72,098 |
$2.86M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19,000 |
10,727 |
$1.24M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,421 |
5,613 |
$1.22M |
| D1310 |
|
22,205 |
22,072 |
$1.01M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
24,976 |
24,451 |
$986K |
| D7140 |
Extraction, erupted tooth or exposed root |
14,779 |
8,540 |
$827K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
8,138 |
4,315 |
$796K |
| D1208 |
Topical application of fluoride, excluding varnish |
45,386 |
45,125 |
$764K |
| D0230 |
Intraoral - periapical each additional radiographic image |
168,942 |
74,694 |
$686K |
| D0272 |
Bitewings - two radiographic images |
56,366 |
56,198 |
$650K |
| D1351 |
Sealant - per tooth |
19,258 |
6,632 |
$576K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,897 |
8,859 |
$567K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,567 |
6,855 |
$562K |
| D9993 |
|
8,103 |
8,084 |
$519K |
| D0220 |
Intraoral - periapical first radiographic image |
25,969 |
25,680 |
$302K |
| D1206 |
Topical application of fluoride varnish |
26,845 |
26,836 |
$297K |
| D0603 |
|
16,724 |
16,626 |
$247K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,835 |
3,820 |
$236K |
| D0350 |
|
21,683 |
12,973 |
$219K |
| D0340 |
|
3,254 |
3,237 |
$162K |
| D0140 |
Limited oral evaluation - problem focused |
3,277 |
3,260 |
$111K |
| D8670 |
Periodic orthodontic treatment visit |
345 |
345 |
$98K |
| D0330 |
Panoramic radiographic image |
3,280 |
3,263 |
$96K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,395 |
759 |
$93K |
| D9430 |
|
2,988 |
2,939 |
$93K |
| D1510 |
|
556 |
459 |
$83K |
| D2140 |
|
1,254 |
823 |
$68K |
| D2330 |
|
810 |
514 |
$62K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
102 |
65 |
$50K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
595 |
474 |
$47K |
| D0602 |
|
1,660 |
1,649 |
$25K |
| D0601 |
|
1,355 |
1,350 |
$20K |
| D1352 |
|
412 |
148 |
$16K |
| D9222 |
|
65 |
65 |
$8K |
| D9610 |
|
98 |
78 |
$7K |
| D0274 |
Bitewings - four radiographic images |
267 |
267 |
$6K |
| D9920 |
|
55 |
55 |
$2K |
| D0270 |
|
316 |
316 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$624.00 |
| D9310 |
|
13 |
13 |
$500.00 |