| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
40,470 |
40,372 |
$2.40M |
| D1120 |
Prophylaxis - child |
51,756 |
51,612 |
$2.13M |
| D1310 |
|
20,859 |
20,804 |
$951K |
| D0230 |
Intraoral - periapical each additional radiographic image |
224,747 |
44,357 |
$901K |
| D1351 |
Sealant - per tooth |
27,005 |
8,733 |
$864K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,078 |
6,800 |
$804K |
| D9993 |
|
9,892 |
9,889 |
$633K |
| D7111 |
|
10,187 |
6,474 |
$581K |
| D1208 |
Topical application of fluoride, excluding varnish |
41,614 |
41,505 |
$512K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,853 |
7,841 |
$510K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,046 |
3,141 |
$498K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,178 |
2,804 |
$498K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,014 |
5,593 |
$488K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,728 |
3,353 |
$384K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,159 |
8,870 |
$362K |
| D0220 |
Intraoral - periapical first radiographic image |
25,851 |
25,565 |
$307K |
| D1206 |
Topical application of fluoride varnish |
11,126 |
11,080 |
$275K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,119 |
4,106 |
$261K |
| D0603 |
|
15,030 |
14,988 |
$225K |
| D0272 |
Bitewings - two radiographic images |
15,545 |
15,490 |
$184K |
| D0350 |
|
15,226 |
9,248 |
$149K |
| D0274 |
Bitewings - four radiographic images |
6,269 |
6,263 |
$135K |
| D2330 |
|
1,411 |
879 |
$108K |
| D0210 |
Intraoral - complete series of radiographic images |
1,931 |
1,931 |
$92K |
| D2140 |
|
1,475 |
928 |
$80K |
| D0601 |
|
4,857 |
4,846 |
$72K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
762 |
638 |
$60K |
| D9430 |
|
1,677 |
1,652 |
$53K |
| D1320 |
|
3,622 |
3,622 |
$36K |
| D1510 |
|
121 |
114 |
$25K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
33 |
24 |
$11K |
| D2160 |
|
90 |
71 |
$7K |
| D2335 |
|
42 |
28 |
$5K |
| D9222 |
|
24 |
24 |
$3K |
| D0602 |
|
177 |
177 |
$3K |
| D0270 |
|
469 |
468 |
$2K |
| D9610 |
|
24 |
24 |
$2K |
| D2332 |
|
17 |
15 |
$1K |
| D2331 |
|
16 |
15 |
$1K |