| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
28,967 |
28,852 |
$1.60M |
| D1120 |
Prophylaxis - child |
33,238 |
33,083 |
$1.29M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,455 |
3,071 |
$999K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,151 |
6,805 |
$804K |
| D0230 |
Intraoral - periapical each additional radiographic image |
180,193 |
34,748 |
$725K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,611 |
2,195 |
$554K |
| D1208 |
Topical application of fluoride, excluding varnish |
33,129 |
32,979 |
$441K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,792 |
3,479 |
$386K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,912 |
7,555 |
$307K |
| D1351 |
Sealant - per tooth |
10,581 |
3,667 |
$292K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,267 |
2,301 |
$258K |
| D0350 |
|
19,879 |
11,467 |
$253K |
| D0272 |
Bitewings - two radiographic images |
21,564 |
21,493 |
$252K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,039 |
2,517 |
$217K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,446 |
2,440 |
$159K |
| D9430 |
|
4,015 |
3,936 |
$126K |
| D9248 |
|
3,393 |
3,287 |
$118K |
| D0220 |
Intraoral - periapical first radiographic image |
9,476 |
9,173 |
$111K |
| D0274 |
Bitewings - four radiographic images |
5,118 |
5,084 |
$109K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,371 |
1,368 |
$83K |
| D2330 |
|
748 |
463 |
$58K |
| D1510 |
|
336 |
300 |
$42K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
88 |
61 |
$40K |
| D1310 |
|
539 |
539 |
$23K |
| D1320 |
|
2,531 |
2,529 |
$22K |
| D2335 |
|
127 |
82 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
171 |
171 |
$8K |
| D9222 |
|
61 |
61 |
$7K |
| D9610 |
|
151 |
73 |
$6K |
| D9221 |
|
12 |
12 |
$5K |
| D9920 |
|
128 |
125 |
$4K |
| D0603 |
|
244 |
244 |
$3K |
| D9220 |
|
12 |
12 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
51 |
$2K |
| D0601 |
|
71 |
71 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
13 |
13 |
$598.00 |
| D9995 |
|
220 |
54 |
$163.92 |
| D9996 |
|
21 |
21 |
$0.00 |
| D9993 |
|
13 |
13 |
$0.00 |