| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
22,727 |
22,656 |
$1.24M |
| D1120 |
Prophylaxis - child |
27,579 |
27,507 |
$1.08M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,774 |
5,630 |
$631K |
| D1351 |
Sealant - per tooth |
18,416 |
6,277 |
$537K |
| D0230 |
Intraoral - periapical each additional radiographic image |
124,948 |
23,634 |
$526K |
| D1310 |
|
8,981 |
8,963 |
$409K |
| D1208 |
Topical application of fluoride, excluding varnish |
25,108 |
25,036 |
$340K |
| D9993 |
|
3,671 |
3,671 |
$237K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,157 |
1,454 |
$210K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,312 |
5,127 |
$208K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,988 |
2,979 |
$195K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,844 |
2,177 |
$150K |
| D0272 |
Bitewings - two radiographic images |
11,491 |
11,470 |
$130K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,996 |
1,991 |
$124K |
| D0274 |
Bitewings - four radiographic images |
5,982 |
5,963 |
$123K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,160 |
1,560 |
$120K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,424 |
1,148 |
$109K |
| D0603 |
|
6,465 |
6,451 |
$96K |
| D0210 |
Intraoral - complete series of radiographic images |
2,125 |
2,125 |
$95K |
| D0220 |
Intraoral - periapical first radiographic image |
5,341 |
5,278 |
$61K |
| D2330 |
|
611 |
409 |
$45K |
| D0350 |
|
4,640 |
3,459 |
$43K |
| D9430 |
|
923 |
908 |
$29K |
| D0602 |
|
1,902 |
1,899 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,097 |
1,095 |
$27K |
| D1510 |
|
96 |
92 |
$17K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
132 |
111 |
$15K |
| D9248 |
|
444 |
438 |
$15K |
| D2331 |
|
16 |
12 |
$1K |
| D0270 |
|
167 |
166 |
$810.00 |
| D1354 |
|
13 |
13 |
$455.00 |