| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
22,299 |
22,215 |
$1.41M |
| D1120 |
Prophylaxis - child |
31,945 |
31,831 |
$1.36M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,686 |
4,765 |
$1.03M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
8,551 |
4,641 |
$847K |
| D1351 |
Sealant - per tooth |
25,683 |
6,596 |
$781K |
| D0230 |
Intraoral - periapical each additional radiographic image |
167,971 |
33,182 |
$684K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,643 |
7,628 |
$501K |
| D1208 |
Topical application of fluoride, excluding varnish |
31,352 |
31,232 |
$474K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,293 |
2,974 |
$355K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,129 |
3,158 |
$351K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,704 |
8,303 |
$346K |
| D1310 |
|
4,703 |
4,662 |
$214K |
| D0272 |
Bitewings - two radiographic images |
16,868 |
16,814 |
$201K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,101 |
3,096 |
$198K |
| D0274 |
Bitewings - four radiographic images |
7,955 |
7,925 |
$170K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,755 |
1,350 |
$140K |
| D9920 |
|
1,195 |
1,178 |
$128K |
| D0220 |
Intraoral - periapical first radiographic image |
9,048 |
8,948 |
$108K |
| D9993 |
|
1,738 |
1,738 |
$103K |
| D9430 |
|
2,575 |
2,553 |
$82K |
| D0603 |
|
4,646 |
4,608 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
521 |
314 |
$28K |
| D9248 |
|
438 |
414 |
$15K |
| D0350 |
|
1,386 |
1,286 |
$7K |
| D1206 |
Topical application of fluoride varnish |
17 |
17 |
$242.00 |