| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
281,853 |
50,580 |
$7.38M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
23,810 |
7,391 |
$2.78M |
| D1120 |
Prophylaxis - child |
76,330 |
74,710 |
$2.41M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
31,287 |
13,220 |
$2.39M |
| D1206 |
Topical application of fluoride varnish |
130,248 |
123,256 |
$2.20M |
| D7140 |
Extraction, erupted tooth or exposed root |
22,444 |
11,407 |
$1.96M |
| D0120 |
Periodic oral evaluation - established patient |
82,063 |
80,391 |
$1.82M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21,539 |
11,458 |
$1.52M |
| D2390 |
|
10,093 |
3,289 |
$1.42M |
| D1110 |
Prophylaxis - adult |
26,536 |
25,970 |
$1.13M |
| D0274 |
Bitewings - four radiographic images |
35,721 |
34,961 |
$1.03M |
| D0272 |
Bitewings - two radiographic images |
43,284 |
42,258 |
$890K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
23,473 |
21,885 |
$693K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
11,156 |
4,584 |
$670K |
| D0330 |
Panoramic radiographic image |
17,482 |
17,072 |
$667K |
| D0240 |
|
41,358 |
23,653 |
$601K |
| D0230 |
Intraoral - periapical each additional radiographic image |
57,941 |
20,451 |
$576K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,793 |
12,441 |
$386K |
| D0220 |
Intraoral - periapical first radiographic image |
29,394 |
28,074 |
$357K |
| D0140 |
Limited oral evaluation - problem focused |
11,916 |
11,433 |
$349K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,977 |
1,941 |
$239K |
| D2330 |
|
3,296 |
1,565 |
$223K |
| D0145 |
Oral evaluation for a patient under three years of age |
7,590 |
7,431 |
$223K |
| D2332 |
|
2,198 |
1,216 |
$213K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
614 |
345 |
$134K |
| D9219 |
|
5,425 |
5,209 |
$96K |
| D0460 |
|
8,271 |
3,354 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,138 |
4,845 |
$79K |
| D9610 |
|
3,331 |
3,217 |
$64K |
| D9420 |
|
524 |
500 |
$40K |
| D1510 |
|
239 |
174 |
$38K |
| D2335 |
|
245 |
141 |
$26K |
| D9222 |
|
338 |
317 |
$25K |
| D9920 |
|
1,009 |
961 |
$6K |
| D2331 |
|
19 |
12 |
$1K |
| D0270 |
|
83 |
82 |
$907.58 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
12 |
$63.60 |
| D0603 |
|
720 |
710 |
$0.00 |
| D1330 |
|
18 |
18 |
$0.00 |