| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,289 |
13,214 |
$709K |
| D1120 |
Prophylaxis - child |
15,573 |
15,484 |
$589K |
| D0230 |
Intraoral - periapical each additional radiographic image |
69,918 |
13,330 |
$287K |
| D1351 |
Sealant - per tooth |
9,103 |
2,767 |
$272K |
| D1310 |
|
5,926 |
5,902 |
$267K |
| D9993 |
|
4,618 |
4,606 |
$266K |
| D1206 |
Topical application of fluoride varnish |
17,401 |
17,299 |
$236K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,620 |
3,597 |
$222K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,801 |
1,937 |
$187K |
| D0210 |
Intraoral - complete series of radiographic images |
3,038 |
3,010 |
$140K |
| D0274 |
Bitewings - four radiographic images |
6,197 |
6,164 |
$131K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,525 |
2,327 |
$96K |
| D1354 |
|
3,793 |
2,265 |
$79K |
| D0272 |
Bitewings - two radiographic images |
5,578 |
5,554 |
$65K |
| D0603 |
|
4,463 |
4,447 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,094 |
852 |
$59K |
| D1110 |
Prophylaxis - adult |
629 |
628 |
$55K |
| D0350 |
|
4,701 |
2,673 |
$45K |
| D0145 |
Oral evaluation for a patient under three years of age |
703 |
700 |
$39K |
| D9430 |
|
1,060 |
1,031 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
578 |
399 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,066 |
2,041 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
273 |
229 |
$22K |
| D0602 |
|
961 |
957 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
101 |
53 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
101 |
53 |
$9K |
| D4341 |
|
43 |
12 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
24 |
15 |
$3K |
| D2330 |
|
18 |
13 |
$1K |
| D9248 |
|
38 |
38 |
$1K |