| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
29,281 |
29,179 |
$1.26M |
| D0120 |
Periodic oral evaluation - established patient |
18,461 |
18,391 |
$1.16M |
| D1310 |
|
16,199 |
16,132 |
$736K |
| D0230 |
Intraoral - periapical each additional radiographic image |
109,077 |
23,515 |
$435K |
| D9993 |
|
6,235 |
6,234 |
$389K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,512 |
5,498 |
$360K |
| D1206 |
Topical application of fluoride varnish |
13,875 |
13,828 |
$349K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,798 |
2,546 |
$250K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,667 |
3,654 |
$244K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,082 |
5,868 |
$241K |
| D0220 |
Intraoral - periapical first radiographic image |
17,319 |
17,060 |
$204K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,649 |
13,600 |
$161K |
| D0603 |
|
10,506 |
10,468 |
$155K |
| D1351 |
Sealant - per tooth |
3,983 |
1,214 |
$123K |
| D9430 |
|
3,639 |
3,572 |
$115K |
| D0272 |
Bitewings - two radiographic images |
8,315 |
8,295 |
$97K |
| D0602 |
|
4,374 |
4,360 |
$65K |
| D0350 |
|
6,528 |
3,298 |
$57K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
358 |
191 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
749 |
503 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
760 |
587 |
$40K |
| D1354 |
|
2,877 |
1,226 |
$37K |
| D0340 |
|
657 |
655 |
$32K |
| D1320 |
|
3,195 |
3,195 |
$31K |
| D0330 |
Panoramic radiographic image |
911 |
908 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
584 |
584 |
$19K |
| D9920 |
|
82 |
81 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
13 |
12 |
$1K |
| D0601 |
|
36 |
36 |
$540.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$45.12 |