| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,264 |
8,218 |
$401K |
| D0120 |
Periodic oral evaluation - established patient |
4,497 |
4,467 |
$307K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,371 |
709 |
$277K |
| D1310 |
|
4,364 |
4,336 |
$195K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,755 |
2,740 |
$184K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,836 |
7,792 |
$160K |
| D0350 |
|
16,469 |
5,915 |
$123K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,718 |
1,218 |
$113K |
| D1351 |
Sealant - per tooth |
3,075 |
972 |
$111K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,011 |
344 |
$99K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,800 |
6,455 |
$93K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,149 |
1,145 |
$79K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,735 |
1,559 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,232 |
768 |
$69K |
| D0603 |
|
3,346 |
3,327 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
824 |
626 |
$44K |
| D0274 |
Bitewings - four radiographic images |
2,156 |
2,139 |
$39K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
136 |
84 |
$27K |
| D0272 |
Bitewings - two radiographic images |
2,254 |
2,236 |
$26K |
| D3230 |
|
255 |
64 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,024 |
2,011 |
$24K |
| D9993 |
|
368 |
368 |
$24K |
| D9430 |
|
415 |
411 |
$13K |
| D9222 |
|
84 |
84 |
$10K |
| D0602 |
|
630 |
624 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
165 |
159 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
63 |
40 |
$5K |
| D0330 |
Panoramic radiographic image |
175 |
171 |
$5K |
| D1354 |
|
85 |
12 |
$1K |