| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
15,673 |
15,573 |
$1.10M |
| D1120 |
Prophylaxis - child |
20,662 |
20,530 |
$1.00M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,821 |
4,069 |
$510K |
| D1310 |
|
10,098 |
10,042 |
$462K |
| D1351 |
Sealant - per tooth |
9,964 |
3,023 |
$346K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,689 |
1,507 |
$315K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,268 |
7,026 |
$290K |
| D1206 |
Topical application of fluoride varnish |
7,505 |
7,459 |
$219K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,547 |
2,535 |
$178K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,904 |
1,793 |
$162K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,111 |
12,031 |
$157K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,900 |
1,882 |
$135K |
| D0603 |
|
8,334 |
8,290 |
$124K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,140 |
1,517 |
$113K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,125 |
735 |
$108K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,518 |
13,829 |
$106K |
| D0274 |
Bitewings - four radiographic images |
4,735 |
4,717 |
$99K |
| D0272 |
Bitewings - two radiographic images |
7,047 |
6,996 |
$83K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,044 |
724 |
$81K |
| D9993 |
|
1,189 |
1,189 |
$77K |
| D0350 |
|
3,480 |
2,232 |
$37K |
| D0270 |
|
6,429 |
6,357 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,721 |
2,677 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
581 |
571 |
$26K |
| D9430 |
|
713 |
701 |
$23K |
| D1510 |
|
107 |
94 |
$22K |
| D0330 |
Panoramic radiographic image |
614 |
596 |
$18K |
| D2330 |
|
198 |
134 |
$15K |
| D0601 |
|
974 |
967 |
$14K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
34 |
14 |
$10K |
| D2332 |
|
43 |
31 |
$3K |
| D1354 |
|
218 |
77 |
$2K |
| D9222 |
|
14 |
14 |
$2K |
| D9610 |
|
46 |
14 |
$1K |
| D0602 |
|
13 |
13 |
$195.00 |