| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
54,897 |
54,740 |
$3.19M |
| D1120 |
Prophylaxis - child |
61,357 |
61,149 |
$2.49M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
28,247 |
9,444 |
$1.53M |
| D2330 |
|
16,995 |
6,213 |
$1.32M |
| D1351 |
Sealant - per tooth |
41,492 |
14,035 |
$1.22M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,916 |
8,082 |
$1.14M |
| D0230 |
Intraoral - periapical each additional radiographic image |
279,613 |
57,486 |
$1.12M |
| D1310 |
|
22,241 |
22,172 |
$1.02M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
23,179 |
22,238 |
$919K |
| D9993 |
|
10,782 |
10,782 |
$698K |
| D1208 |
Topical application of fluoride, excluding varnish |
54,887 |
54,711 |
$657K |
| D0220 |
Intraoral - periapical first radiographic image |
45,813 |
45,197 |
$545K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,395 |
7,377 |
$490K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,355 |
2,575 |
$430K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,387 |
2,221 |
$394K |
| D7111 |
|
6,905 |
5,077 |
$393K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,795 |
4,785 |
$305K |
| D0350 |
|
26,245 |
12,405 |
$293K |
| D1206 |
Topical application of fluoride varnish |
11,458 |
11,415 |
$284K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,978 |
2,497 |
$266K |
| D0603 |
|
14,439 |
14,385 |
$216K |
| D0272 |
Bitewings - two radiographic images |
13,260 |
13,256 |
$155K |
| D9430 |
|
4,488 |
4,321 |
$143K |
| D0210 |
Intraoral - complete series of radiographic images |
2,687 |
2,687 |
$129K |
| D0601 |
|
7,555 |
7,540 |
$113K |
| D2140 |
|
1,899 |
1,032 |
$103K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,271 |
838 |
$101K |
| D1320 |
|
5,395 |
5,394 |
$54K |
| D0274 |
Bitewings - four radiographic images |
2,279 |
2,279 |
$49K |
| D2335 |
|
305 |
218 |
$36K |
| D2932 |
|
156 |
67 |
$16K |
| D2331 |
|
184 |
142 |
$14K |
| D0330 |
Panoramic radiographic image |
402 |
394 |
$12K |
| D1510 |
|
100 |
94 |
$12K |
| D2332 |
|
62 |
51 |
$5K |
| D2160 |
|
31 |
27 |
$2K |
| D0270 |
|
172 |
172 |
$860.00 |