| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
48,169 |
47,948 |
$2.79M |
| D1120 |
Prophylaxis - child |
60,212 |
59,889 |
$2.40M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28,425 |
19,292 |
$1.85M |
| D1310 |
|
22,399 |
22,323 |
$1.02M |
| D1206 |
Topical application of fluoride varnish |
47,888 |
47,582 |
$781K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13,716 |
9,688 |
$719K |
| D9993 |
|
11,197 |
11,190 |
$716K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
8,341 |
6,956 |
$646K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15,717 |
15,455 |
$616K |
| D0350 |
|
46,288 |
26,094 |
$476K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,401 |
7,353 |
$476K |
| D0272 |
Bitewings - two radiographic images |
33,205 |
33,039 |
$382K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,660 |
2,221 |
$307K |
| D0603 |
|
19,646 |
19,576 |
$291K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,475 |
4,457 |
$282K |
| D0230 |
Intraoral - periapical each additional radiographic image |
57,838 |
29,479 |
$221K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,968 |
1,632 |
$192K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,237 |
2,477 |
$180K |
| D0274 |
Bitewings - four radiographic images |
8,391 |
8,326 |
$177K |
| D7111 |
|
2,484 |
1,821 |
$140K |
| D0330 |
Panoramic radiographic image |
4,631 |
4,601 |
$133K |
| D1351 |
Sealant - per tooth |
4,198 |
1,998 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,714 |
10,702 |
$93K |
| D0220 |
Intraoral - periapical first radiographic image |
7,801 |
7,701 |
$90K |
| D0210 |
Intraoral - complete series of radiographic images |
1,684 |
1,676 |
$80K |
| D9430 |
|
1,335 |
1,311 |
$42K |
| D0602 |
|
1,219 |
1,213 |
$18K |
| D2330 |
|
134 |
100 |
$9K |
| D1354 |
|
44 |
26 |
$875.00 |