| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
27,016 |
26,930 |
$1.23M |
| D0120 |
Periodic oral evaluation - established patient |
16,541 |
16,480 |
$1.08M |
| D1310 |
|
16,377 |
16,331 |
$746K |
| D0230 |
Intraoral - periapical each additional radiographic image |
98,229 |
20,387 |
$394K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,249 |
5,234 |
$360K |
| D1206 |
Topical application of fluoride varnish |
12,935 |
12,896 |
$349K |
| D9993 |
|
5,262 |
5,261 |
$323K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,918 |
3,909 |
$268K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
319 |
252 |
$205K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,982 |
2,077 |
$198K |
| D0220 |
Intraoral - periapical first radiographic image |
16,595 |
16,289 |
$197K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,818 |
4,592 |
$193K |
| D1351 |
Sealant - per tooth |
5,656 |
1,781 |
$186K |
| D0603 |
|
10,832 |
10,799 |
$161K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,560 |
12,516 |
$156K |
| D9430 |
|
2,944 |
2,897 |
$94K |
| D0350 |
|
9,760 |
4,227 |
$80K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,253 |
959 |
$67K |
| D0602 |
|
4,404 |
4,394 |
$66K |
| D0272 |
Bitewings - two radiographic images |
5,532 |
5,518 |
$65K |
| D1354 |
|
4,711 |
1,582 |
$56K |
| D9920 |
|
595 |
586 |
$54K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
373 |
186 |
$45K |
| D1320 |
|
3,619 |
3,618 |
$36K |
| D0340 |
|
643 |
643 |
$32K |
| D9222 |
|
251 |
251 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
494 |
320 |
$28K |
| D0330 |
Panoramic radiographic image |
787 |
786 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
698 |
698 |
$23K |
| D9610 |
|
315 |
255 |
$22K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
102 |
55 |
$10K |