| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
32,702 |
32,474 |
$1.00M |
| D1206 |
Topical application of fluoride varnish |
30,593 |
30,367 |
$742K |
| D1120 |
Prophylaxis - child |
24,286 |
24,114 |
$705K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,129 |
1,477 |
$452K |
| D1110 |
Prophylaxis - adult |
8,759 |
8,695 |
$399K |
| D0272 |
Bitewings - two radiographic images |
14,629 |
14,516 |
$361K |
| D0274 |
Bitewings - four radiographic images |
5,028 |
5,001 |
$191K |
| D1351 |
Sealant - per tooth |
6,909 |
1,734 |
$184K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,891 |
1,657 |
$175K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,662 |
7,182 |
$106K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,310 |
893 |
$106K |
| D0330 |
Panoramic radiographic image |
1,140 |
1,130 |
$75K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,321 |
907 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
3,022 |
2,984 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
840 |
828 |
$28K |
| D2140 |
|
852 |
640 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,081 |
1,069 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
432 |
326 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,365 |
1,239 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
523 |
300 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,503 |
2,498 |
$6K |
| D9420 |
|
406 |
387 |
$5K |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
13 |
12 |
$473.55 |
| D1354 |
|
15 |
15 |
$384.30 |
| D2330 |
|
112 |
75 |
$0.00 |