| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
25,353 |
25,209 |
$1.22M |
| D0120 |
Periodic oral evaluation - established patient |
16,262 |
16,154 |
$1.17M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,968 |
8,090 |
$851K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,734 |
5,344 |
$519K |
| D0230 |
Intraoral - periapical each additional radiographic image |
125,862 |
24,150 |
$512K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,413 |
7,386 |
$496K |
| D1206 |
Topical application of fluoride varnish |
25,280 |
25,133 |
$443K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,996 |
9,655 |
$397K |
| D1310 |
|
6,705 |
6,666 |
$304K |
| D1351 |
Sealant - per tooth |
8,464 |
2,877 |
$285K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,265 |
1,424 |
$264K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,126 |
2,719 |
$230K |
| D0274 |
Bitewings - four radiographic images |
8,174 |
8,118 |
$175K |
| D0350 |
|
16,271 |
8,767 |
$161K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,433 |
879 |
$140K |
| D0272 |
Bitewings - two radiographic images |
11,375 |
11,311 |
$134K |
| D9430 |
|
4,185 |
3,991 |
$134K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,583 |
1,319 |
$123K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,560 |
1,553 |
$110K |
| D0603 |
|
4,651 |
4,622 |
$68K |
| D9993 |
|
889 |
888 |
$52K |
| D8670 |
Periodic orthodontic treatment visit |
138 |
138 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
953 |
953 |
$33K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
166 |
54 |
$28K |
| D0330 |
Panoramic radiographic image |
937 |
937 |
$28K |
| D2330 |
|
300 |
195 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
345 |
345 |
$16K |
| D2932 |
|
86 |
41 |
$9K |
| D1510 |
|
29 |
28 |
$6K |
| D0602 |
|
407 |
404 |
$6K |
| D0601 |
|
367 |
367 |
$5K |
| D9222 |
|
42 |
42 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
188 |
182 |
$2K |
| D9610 |
|
28 |
12 |
$1K |