| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
46,739 |
46,548 |
$2.77M |
| D1120 |
Prophylaxis - child |
63,272 |
62,993 |
$2.63M |
| D1310 |
|
27,955 |
27,847 |
$1.27M |
| D0230 |
Intraoral - periapical each additional radiographic image |
248,165 |
54,038 |
$984K |
| D9993 |
|
12,078 |
12,073 |
$754K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,787 |
7,019 |
$714K |
| D1206 |
Topical application of fluoride varnish |
25,460 |
25,359 |
$612K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,594 |
8,551 |
$560K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,542 |
11,230 |
$456K |
| D0145 |
Oral evaluation for a patient under three years of age |
6,931 |
6,909 |
$444K |
| D1351 |
Sealant - per tooth |
14,847 |
4,362 |
$439K |
| D0220 |
Intraoral - periapical first radiographic image |
37,212 |
36,699 |
$437K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
504 |
480 |
$401K |
| D1208 |
Topical application of fluoride, excluding varnish |
35,502 |
35,350 |
$400K |
| D0603 |
|
19,288 |
19,215 |
$286K |
| D9430 |
|
8,519 |
8,343 |
$267K |
| D0272 |
Bitewings - two radiographic images |
21,940 |
21,851 |
$256K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,590 |
2,712 |
$191K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,109 |
2,083 |
$176K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,404 |
784 |
$166K |
| D0350 |
|
15,544 |
7,298 |
$128K |
| D0602 |
|
6,607 |
6,579 |
$98K |
| D0340 |
|
1,857 |
1,857 |
$91K |
| D1354 |
|
6,437 |
2,421 |
$79K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
772 |
439 |
$76K |
| D0330 |
Panoramic radiographic image |
2,220 |
2,219 |
$64K |
| D9222 |
|
480 |
480 |
$59K |
| D1320 |
|
5,829 |
5,825 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,798 |
1,795 |
$54K |
| D9920 |
|
403 |
399 |
$44K |
| D9610 |
|
521 |
481 |
$40K |
| D2330 |
|
116 |
68 |
$9K |
| D0601 |
|
490 |
489 |
$7K |
| D9995 |
|
64 |
64 |
$937.44 |
| D9999 |
Unspecified adjunctive procedure, by report |
59 |
59 |
$596.77 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$151.20 |
| D8660 |
|
83 |
83 |
$0.00 |