| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,043 |
7,024 |
$283K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,417 |
1,016 |
$278K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,079 |
1,672 |
$269K |
| D1120 |
Prophylaxis - child |
9,128 |
9,085 |
$269K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,862 |
1,761 |
$260K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,965 |
835 |
$192K |
| D2330 |
|
2,501 |
917 |
$191K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,940 |
1,500 |
$167K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33,076 |
9,254 |
$136K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,542 |
3,332 |
$136K |
| D1351 |
Sealant - per tooth |
5,750 |
1,918 |
$123K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,103 |
9,059 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,567 |
1,564 |
$92K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,079 |
516 |
$70K |
| D0272 |
Bitewings - two radiographic images |
5,572 |
5,551 |
$64K |
| D9993 |
|
716 |
715 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
2,970 |
2,838 |
$34K |
| D0145 |
Oral evaluation for a patient under three years of age |
645 |
645 |
$33K |
| D1310 |
|
721 |
719 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
411 |
267 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,523 |
1,521 |
$32K |
| D9430 |
|
1,003 |
990 |
$31K |
| D2160 |
|
223 |
160 |
$17K |
| D1510 |
|
143 |
129 |
$17K |
| D9920 |
|
80 |
71 |
$10K |
| D2140 |
|
167 |
118 |
$9K |
| D3240 |
|
82 |
48 |
$8K |
| D0603 |
|
498 |
492 |
$7K |
| D2331 |
|
80 |
55 |
$6K |
| D0601 |
|
132 |
130 |
$2K |
| D0602 |
|
56 |
56 |
$765.00 |