| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
45,532 |
45,351 |
$2.65M |
| D1120 |
Prophylaxis - child |
58,029 |
57,773 |
$2.36M |
| D1310 |
|
20,986 |
20,879 |
$954K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,492 |
7,976 |
$952K |
| D1208 |
Topical application of fluoride, excluding varnish |
44,230 |
44,015 |
$694K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15,602 |
14,947 |
$617K |
| D9993 |
|
8,428 |
8,412 |
$540K |
| D0230 |
Intraoral - periapical each additional radiographic image |
129,495 |
50,699 |
$521K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,935 |
7,906 |
$510K |
| D0272 |
Bitewings - two radiographic images |
38,208 |
38,028 |
$444K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,766 |
4,740 |
$438K |
| D1351 |
Sealant - per tooth |
12,862 |
3,932 |
$397K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,190 |
1,973 |
$376K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,362 |
2,016 |
$330K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,535 |
3,813 |
$293K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,076 |
4,068 |
$259K |
| D0603 |
|
13,747 |
13,670 |
$204K |
| D1206 |
Topical application of fluoride varnish |
11,343 |
11,313 |
$165K |
| D0220 |
Intraoral - periapical first radiographic image |
11,694 |
11,532 |
$137K |
| D9430 |
|
4,241 |
4,134 |
$132K |
| D0140 |
Limited oral evaluation - problem focused |
3,238 |
3,230 |
$112K |
| D0330 |
Panoramic radiographic image |
3,326 |
3,315 |
$96K |
| D0350 |
|
8,855 |
5,705 |
$87K |
| D0274 |
Bitewings - four radiographic images |
3,658 |
3,649 |
$76K |
| D0340 |
|
1,498 |
1,489 |
$75K |
| D0602 |
|
2,600 |
2,591 |
$39K |
| D0601 |
|
2,030 |
2,019 |
$30K |
| D1510 |
|
114 |
102 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
121 |
104 |
$9K |
| D2330 |
|
104 |
76 |
$8K |
| D2331 |
|
16 |
12 |
$1K |
| D0270 |
|
235 |
229 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$31.20 |
| D8660 |
|
22 |
22 |
$0.00 |
| D4346 |
|
34 |
34 |
$0.00 |