| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
105,002 |
104,563 |
$5.67M |
| D1120 |
Prophylaxis - child |
138,352 |
137,686 |
$5.27M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
61,935 |
29,349 |
$4.07M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
32,736 |
15,728 |
$3.79M |
| D1351 |
Sealant - per tooth |
94,062 |
30,488 |
$2.53M |
| D1208 |
Topical application of fluoride, excluding varnish |
133,652 |
133,022 |
$1.92M |
| D1310 |
|
42,326 |
42,180 |
$1.92M |
| D7140 |
Extraction, erupted tooth or exposed root |
32,712 |
17,094 |
$1.84M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
45,563 |
44,441 |
$1.78M |
| D0230 |
Intraoral - periapical each additional radiographic image |
383,495 |
112,643 |
$1.63M |
| D3240 |
|
13,996 |
7,217 |
$1.37M |
| D9993 |
|
20,498 |
20,487 |
$1.32M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
20,329 |
20,245 |
$1.31M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24,269 |
15,408 |
$1.29M |
| D2932 |
|
8,420 |
3,723 |
$867K |
| D0274 |
Bitewings - four radiographic images |
35,960 |
35,802 |
$746K |
| D0145 |
Oral evaluation for a patient under three years of age |
11,550 |
11,490 |
$699K |
| D0272 |
Bitewings - two radiographic images |
61,980 |
61,670 |
$690K |
| D1510 |
|
3,821 |
3,337 |
$550K |
| D0220 |
Intraoral - periapical first radiographic image |
45,514 |
44,839 |
$523K |
| D0603 |
|
32,128 |
31,987 |
$473K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
6,047 |
4,559 |
$471K |
| D0350 |
|
44,616 |
26,612 |
$454K |
| D2330 |
|
4,043 |
2,704 |
$305K |
| D3230 |
|
2,876 |
1,208 |
$283K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,399 |
1,140 |
$233K |
| D9430 |
|
5,630 |
5,522 |
$176K |
| D0602 |
|
8,468 |
8,465 |
$126K |
| D9920 |
|
491 |
480 |
$40K |
| D2331 |
|
429 |
329 |
$32K |
| D1515 |
|
63 |
54 |
$11K |
| D1516 |
|
46 |
44 |
$8K |
| D1999 |
|
1,030 |
1,018 |
$6K |
| D1206 |
Topical application of fluoride varnish |
843 |
828 |
$5K |
| D0601 |
|
241 |
241 |
$4K |
| D1517 |
|
17 |
17 |
$3K |
| D2332 |
|
23 |
16 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
38 |
$2K |
| D0270 |
|
179 |
179 |
$885.00 |
| D2920 |
|
36 |
27 |
$840.00 |
| D1330 |
|
5,084 |
4,969 |
$0.00 |
| D9215 |
|
109 |
108 |
$0.00 |