| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
41,812 |
41,657 |
$2.37M |
| D1120 |
Prophylaxis - child |
50,309 |
50,044 |
$1.99M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,064 |
4,426 |
$1.06M |
| D0230 |
Intraoral - periapical each additional radiographic image |
247,570 |
49,246 |
$1.02M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,450 |
6,420 |
$944K |
| D1351 |
Sealant - per tooth |
32,284 |
8,919 |
$923K |
| D1208 |
Topical application of fluoride, excluding varnish |
50,273 |
49,984 |
$729K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,404 |
3,390 |
$716K |
| D1310 |
|
13,007 |
12,956 |
$591K |
| D7140 |
Extraction, erupted tooth or exposed root |
10,173 |
5,419 |
$570K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,644 |
3,769 |
$402K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,081 |
6,073 |
$392K |
| D0272 |
Bitewings - two radiographic images |
31,106 |
30,968 |
$357K |
| D9993 |
|
5,307 |
5,307 |
$341K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,277 |
5,263 |
$323K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,338 |
7,037 |
$285K |
| D0274 |
Bitewings - four radiographic images |
12,296 |
12,231 |
$256K |
| D2335 |
|
2,176 |
758 |
$251K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,597 |
1,536 |
$236K |
| D2330 |
|
2,982 |
1,522 |
$223K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,591 |
1,703 |
$201K |
| D0603 |
|
12,299 |
12,251 |
$182K |
| D1510 |
|
1,198 |
983 |
$178K |
| D9430 |
|
4,847 |
4,711 |
$152K |
| D9248 |
|
4,436 |
4,233 |
$150K |
| D0220 |
Intraoral - periapical first radiographic image |
11,792 |
11,430 |
$138K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
306 |
148 |
$123K |
| D0350 |
|
8,804 |
4,761 |
$83K |
| D9420 |
|
777 |
528 |
$65K |
| D2332 |
|
711 |
436 |
$58K |
| D0330 |
Panoramic radiographic image |
1,104 |
1,104 |
$33K |
| D9221 |
|
84 |
51 |
$30K |
| D2160 |
|
378 |
259 |
$28K |
| D8670 |
Periodic orthodontic treatment visit |
98 |
98 |
$28K |
| D9222 |
|
149 |
148 |
$18K |
| D2140 |
|
345 |
174 |
$17K |
| D9610 |
|
224 |
188 |
$16K |
| D9220 |
|
51 |
51 |
$12K |
| D0602 |
|
504 |
504 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
115 |
115 |
$5K |
| D0270 |
|
697 |
690 |
$3K |
| D9920 |
|
821 |
780 |
$3K |
| D1354 |
|
39 |
13 |
$372.00 |
| D1330 |
|
412 |
412 |
$0.00 |