| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
57,437 |
54,258 |
$2.13M |
| D0120 |
Periodic oral evaluation - established patient |
60,029 |
56,905 |
$1.83M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,607 |
4,045 |
$1.72M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,315 |
7,427 |
$1.59M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,567 |
6,646 |
$1.12M |
| D1351 |
Sealant - per tooth |
33,144 |
6,264 |
$922K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
21,089 |
19,049 |
$868K |
| D1206 |
Topical application of fluoride varnish |
39,274 |
38,078 |
$787K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,061 |
3,820 |
$716K |
| D0274 |
Bitewings - four radiographic images |
21,931 |
20,665 |
$700K |
| D1110 |
Prophylaxis - adult |
10,550 |
10,019 |
$544K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,540 |
8,664 |
$503K |
| D2140 |
|
5,195 |
2,713 |
$442K |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
1,820 |
733 |
$438K |
| D1208 |
Topical application of fluoride, excluding varnish |
25,505 |
23,185 |
$419K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,473 |
2,499 |
$410K |
| D0140 |
Limited oral evaluation - problem focused |
6,032 |
5,645 |
$273K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,791 |
1,517 |
$267K |
| D0330 |
Panoramic radiographic image |
4,529 |
4,221 |
$195K |
| D0272 |
Bitewings - two radiographic images |
6,419 |
6,060 |
$170K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
952 |
773 |
$149K |
| D1510 |
|
739 |
519 |
$122K |
| D0220 |
Intraoral - periapical first radiographic image |
8,521 |
7,886 |
$82K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
174 |
171 |
$81K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,250 |
4,672 |
$66K |
| D0240 |
|
4,752 |
4,460 |
$46K |
| D9310 |
|
1,282 |
1,193 |
$32K |
| D9222 |
|
173 |
170 |
$30K |
| D1354 |
|
830 |
372 |
$25K |
| D7111 |
|
197 |
139 |
$11K |
| D2330 |
|
137 |
82 |
$10K |
| D1330 |
|
760 |
611 |
$7K |
| D2331 |
|
56 |
41 |
$6K |
| D2332 |
|
25 |
14 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
63 |
59 |
$3K |
| D0603 |
|
370 |
344 |
$0.00 |