| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
18,021 |
17,982 |
$1.07M |
| D1120 |
Prophylaxis - child |
24,156 |
24,089 |
$910K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,845 |
22,779 |
$322K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,575 |
4,566 |
$286K |
| D1310 |
|
6,625 |
6,616 |
$263K |
| D9993 |
|
3,351 |
3,351 |
$212K |
| D0272 |
Bitewings - two radiographic images |
17,665 |
17,616 |
$199K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,024 |
2,024 |
$124K |
| D9430 |
|
3,487 |
3,348 |
$108K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,491 |
1,069 |
$94K |
| D0220 |
Intraoral - periapical first radiographic image |
5,837 |
5,722 |
$65K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,201 |
980 |
$64K |
| D1351 |
Sealant - per tooth |
2,079 |
496 |
$50K |
| D0601 |
|
5,039 |
5,030 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
744 |
562 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
781 |
606 |
$39K |
| D0330 |
Panoramic radiographic image |
1,237 |
1,236 |
$35K |
| D0350 |
|
2,301 |
1,762 |
$21K |
| D0274 |
Bitewings - four radiographic images |
728 |
728 |
$15K |
| D1206 |
Topical application of fluoride varnish |
842 |
842 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,159 |
1,971 |
$12K |
| D0603 |
|
997 |
997 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
162 |
159 |
$6K |
| D0602 |
|
391 |
391 |
$4K |
| D2940 |
|
39 |
32 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13 |
13 |
$1K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
12 |
12 |
$1K |
| D2140 |
|
14 |
13 |
$764.40 |