| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
28,114 |
27,933 |
$1.20M |
| D0120 |
Periodic oral evaluation - established patient |
18,254 |
18,151 |
$1.17M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,852 |
5,507 |
$722K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,074 |
2,565 |
$712K |
| D1310 |
|
14,321 |
14,241 |
$631K |
| D1208 |
Topical application of fluoride, excluding varnish |
26,451 |
26,289 |
$460K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,760 |
6,733 |
$448K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,632 |
1,921 |
$445K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,124 |
3,123 |
$342K |
| D9993 |
|
5,524 |
5,522 |
$313K |
| D0230 |
Intraoral - periapical each additional radiographic image |
69,867 |
24,738 |
$303K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,226 |
6,824 |
$288K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,941 |
3,073 |
$264K |
| D1351 |
Sealant - per tooth |
7,994 |
2,755 |
$240K |
| D0272 |
Bitewings - two radiographic images |
19,152 |
18,992 |
$221K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,288 |
3,274 |
$217K |
| D0603 |
|
10,026 |
9,971 |
$144K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,439 |
989 |
$115K |
| D9430 |
|
3,102 |
3,014 |
$98K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
647 |
158 |
$88K |
| D1510 |
|
509 |
415 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
5,568 |
5,323 |
$66K |
| D9248 |
|
1,600 |
1,465 |
$57K |
| D2330 |
|
740 |
409 |
$55K |
| D0350 |
|
5,036 |
2,606 |
$51K |
| D0602 |
|
3,111 |
3,091 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
1,252 |
1,250 |
$43K |
| D0330 |
Panoramic radiographic image |
1,175 |
1,173 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,283 |
1,281 |
$27K |
| D9222 |
|
159 |
158 |
$19K |
| D0601 |
|
803 |
803 |
$12K |
| D9610 |
|
311 |
157 |
$12K |
| D2332 |
|
95 |
79 |
$8K |
| D0270 |
|
417 |
411 |
$2K |
| D1354 |
|
37 |
36 |
$1K |
| D9310 |
|
30 |
27 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
77 |
77 |
$916.00 |
| D1206 |
Topical application of fluoride varnish |
57 |
56 |
$820.00 |
| D1999 |
|
2,570 |
2,302 |
$796.25 |
| D1330 |
|
6,226 |
6,216 |
$0.00 |