| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
25,623 |
25,544 |
$1.52M |
| D1120 |
Prophylaxis - child |
34,027 |
33,903 |
$1.37M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,288 |
6,758 |
$808K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,425 |
2,754 |
$635K |
| D1310 |
|
12,082 |
12,048 |
$541K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,043 |
2,448 |
$493K |
| D1208 |
Topical application of fluoride, excluding varnish |
31,685 |
31,576 |
$489K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,025 |
4,019 |
$395K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,800 |
9,203 |
$388K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,708 |
5,697 |
$370K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,852 |
4,558 |
$363K |
| D0230 |
Intraoral - periapical each additional radiographic image |
82,767 |
31,413 |
$345K |
| D1351 |
Sealant - per tooth |
9,947 |
3,485 |
$290K |
| D9993 |
|
4,968 |
4,967 |
$286K |
| D0272 |
Bitewings - two radiographic images |
22,786 |
22,693 |
$264K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,735 |
3,725 |
$235K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,668 |
1,297 |
$131K |
| D0603 |
|
8,439 |
8,357 |
$118K |
| D1510 |
|
729 |
608 |
$106K |
| D0274 |
Bitewings - four radiographic images |
4,456 |
4,445 |
$94K |
| D9430 |
|
2,758 |
2,693 |
$87K |
| D0220 |
Intraoral - periapical first radiographic image |
6,023 |
5,850 |
$70K |
| D2330 |
|
906 |
596 |
$69K |
| D9248 |
|
1,869 |
1,786 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
1,496 |
1,491 |
$50K |
| D0602 |
|
3,391 |
3,336 |
$47K |
| D0330 |
Panoramic radiographic image |
1,395 |
1,388 |
$39K |
| D0350 |
|
3,991 |
2,429 |
$37K |
| D0601 |
|
586 |
579 |
$7K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
77 |
16 |
$7K |
| D1206 |
Topical application of fluoride varnish |
455 |
449 |
$4K |
| D9222 |
|
16 |
16 |
$2K |
| D9610 |
|
34 |
16 |
$1K |
| D1354 |
|
22 |
15 |
$490.00 |
| D0270 |
|
48 |
47 |
$235.00 |
| D0210 |
Intraoral - complete series of radiographic images |
18 |
18 |
$144.00 |
| D1999 |
|
702 |
675 |
$68.75 |
| D9930 |
|
14 |
14 |
$0.00 |
| D1330 |
|
7,063 |
7,045 |
$0.00 |