| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
58,496 |
58,303 |
$3.35M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
27,480 |
9,813 |
$3.23M |
| D1120 |
Prophylaxis - child |
72,644 |
72,385 |
$2.88M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
22,364 |
7,908 |
$2.20M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
30,918 |
18,316 |
$2.04M |
| D0230 |
Intraoral - periapical each additional radiographic image |
382,976 |
78,598 |
$1.57M |
| D7140 |
Extraction, erupted tooth or exposed root |
24,980 |
12,372 |
$1.42M |
| D1208 |
Topical application of fluoride, excluding varnish |
67,563 |
67,308 |
$1.00M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14,043 |
14,009 |
$911K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
20,945 |
20,273 |
$823K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
3,354 |
1,286 |
$816K |
| D1351 |
Sealant - per tooth |
26,139 |
9,678 |
$725K |
| D0272 |
Bitewings - two radiographic images |
56,278 |
56,063 |
$656K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
6,926 |
5,245 |
$544K |
| D9430 |
|
15,127 |
14,884 |
$477K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,415 |
5,912 |
$450K |
| D0350 |
|
30,735 |
18,903 |
$351K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,761 |
4,754 |
$293K |
| D9248 |
|
7,536 |
7,377 |
$262K |
| D0220 |
Intraoral - periapical first radiographic image |
21,130 |
20,854 |
$248K |
| D2330 |
|
2,272 |
1,197 |
$174K |
| D9222 |
|
1,287 |
1,285 |
$158K |
| D1310 |
|
3,124 |
3,121 |
$138K |
| D1510 |
|
800 |
591 |
$129K |
| D9610 |
|
3,704 |
1,472 |
$123K |
| D0274 |
Bitewings - four radiographic images |
5,580 |
5,572 |
$116K |
| D0210 |
Intraoral - complete series of radiographic images |
2,394 |
2,384 |
$110K |
| D9221 |
|
178 |
163 |
$98K |
| D0140 |
Limited oral evaluation - problem focused |
2,738 |
2,720 |
$95K |
| D9920 |
|
1,328 |
1,296 |
$85K |
| D1206 |
Topical application of fluoride varnish |
6,297 |
6,289 |
$75K |
| D1320 |
|
7,338 |
7,334 |
$71K |
| D7230 |
|
282 |
154 |
$53K |
| D9420 |
|
578 |
435 |
$45K |
| D9220 |
|
163 |
163 |
$39K |
| D1110 |
Prophylaxis - adult |
329 |
329 |
$29K |
| D0330 |
Panoramic radiographic image |
912 |
912 |
$26K |
| D0603 |
|
1,711 |
1,710 |
$25K |
| D2335 |
|
159 |
71 |
$18K |
| D2932 |
|
142 |
42 |
$15K |
| D0601 |
|
869 |
867 |
$12K |
| D7220 |
|
43 |
24 |
$6K |
| D0340 |
|
96 |
96 |
$5K |
| D7240 |
Removal of impacted tooth - completely bony |
19 |
12 |
$4K |
| D2332 |
|
47 |
36 |
$4K |
| D0270 |
|
784 |
770 |
$4K |
| D2933 |
|
36 |
12 |
$4K |
| D8670 |
Periodic orthodontic treatment visit |
12 |
12 |
$4K |
| D0602 |
|
64 |
64 |
$945.00 |
| D9995 |
|
180 |
85 |
$212.40 |
| D1999 |
|
239 |
236 |
$138.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
19 |
19 |
$47.04 |
| D9996 |
|
14 |
14 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
19 |
19 |
$0.00 |