| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
19,583 |
19,499 |
$891K |
| D0120 |
Periodic oral evaluation - established patient |
13,330 |
13,254 |
$834K |
| D1310 |
|
11,876 |
11,840 |
$516K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,375 |
2,582 |
$353K |
| D1206 |
Topical application of fluoride varnish |
12,140 |
12,099 |
$282K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,634 |
3,626 |
$238K |
| D1351 |
Sealant - per tooth |
6,500 |
2,061 |
$221K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,004 |
4,767 |
$200K |
| D0603 |
|
11,601 |
11,562 |
$169K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,035 |
2,026 |
$140K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,473 |
1,432 |
$139K |
| D9993 |
|
3,542 |
3,540 |
$130K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,011 |
536 |
$120K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,306 |
8,861 |
$96K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,877 |
6,836 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,320 |
780 |
$70K |
| D0272 |
Bitewings - two radiographic images |
5,039 |
4,993 |
$58K |
| D0350 |
|
8,701 |
4,478 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,707 |
3,638 |
$44K |
| D9430 |
|
802 |
778 |
$26K |
| D9920 |
|
184 |
182 |
$18K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
54 |
27 |
$16K |
| D0330 |
Panoramic radiographic image |
477 |
477 |
$14K |
| D1354 |
|
730 |
339 |
$7K |
| D0274 |
Bitewings - four radiographic images |
309 |
309 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
60 |
43 |
$5K |
| D2330 |
|
58 |
36 |
$4K |
| D9222 |
|
27 |
27 |
$3K |
| D0240 |
|
312 |
163 |
$3K |
| D9610 |
|
27 |
27 |
$2K |
| D0601 |
|
15 |
15 |
$225.00 |
| D1999 |
|
196 |
191 |
$0.00 |