| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
30,925 |
30,794 |
$1.50M |
| D0120 |
Periodic oral evaluation - established patient |
18,044 |
17,969 |
$1.24M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,584 |
3,040 |
$779K |
| D1310 |
|
17,386 |
17,290 |
$778K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,982 |
9,951 |
$666K |
| D1351 |
Sealant - per tooth |
18,917 |
5,113 |
$650K |
| D1208 |
Topical application of fluoride, excluding varnish |
30,803 |
30,666 |
$623K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,261 |
2,482 |
$419K |
| D0230 |
Intraoral - periapical each additional radiographic image |
94,187 |
23,218 |
$380K |
| D0350 |
|
46,324 |
17,888 |
$361K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,762 |
6,996 |
$309K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,034 |
2,928 |
$284K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,061 |
4,043 |
$275K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,699 |
2,709 |
$244K |
| D0603 |
|
13,703 |
13,646 |
$200K |
| D0220 |
Intraoral - periapical first radiographic image |
15,019 |
14,851 |
$178K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,949 |
2,241 |
$159K |
| D0274 |
Bitewings - four radiographic images |
7,630 |
7,606 |
$132K |
| D1510 |
|
597 |
481 |
$119K |
| D9993 |
|
1,639 |
1,639 |
$101K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
251 |
136 |
$62K |
| D2330 |
|
754 |
440 |
$59K |
| D9430 |
|
1,739 |
1,702 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
1,064 |
1,060 |
$50K |
| D0602 |
|
3,449 |
3,425 |
$50K |
| D0330 |
Panoramic radiographic image |
1,635 |
1,626 |
$44K |
| D2335 |
|
185 |
121 |
$21K |
| D3230 |
|
192 |
63 |
$19K |
| D9222 |
|
136 |
136 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
99 |
78 |
$8K |
| D0272 |
Bitewings - two radiographic images |
489 |
489 |
$6K |
| D1354 |
|
42 |
12 |
$492.00 |
| D9920 |
|
23 |
19 |
$0.00 |