| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
81,716 |
81,713 |
$2.91M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,113 |
9,944 |
$2.90M |
| D1120 |
Prophylaxis - child |
67,211 |
67,209 |
$2.53M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,632 |
4,059 |
$2.19M |
| D1208 |
Topical application of fluoride, excluding varnish |
55,566 |
55,565 |
$1.39M |
| D1110 |
Prophylaxis - adult |
21,031 |
21,031 |
$1.12M |
| D7140 |
Extraction, erupted tooth or exposed root |
7,820 |
5,427 |
$1.12M |
| D0330 |
Panoramic radiographic image |
12,509 |
12,507 |
$861K |
| D1206 |
Topical application of fluoride varnish |
30,077 |
30,073 |
$810K |
| D0272 |
Bitewings - two radiographic images |
23,296 |
23,295 |
$660K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,674 |
1,884 |
$596K |
| D0274 |
Bitewings - four radiographic images |
11,913 |
11,913 |
$527K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,448 |
1,347 |
$383K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,557 |
2,197 |
$329K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,390 |
5,390 |
$236K |
| D0240 |
|
2,437 |
2,435 |
$72K |
| D9420 |
|
1,108 |
1,108 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
2,708 |
2,703 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
7,933 |
7,927 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,437 |
1,413 |
$43K |
| D1351 |
Sealant - per tooth |
197 |
196 |
$37K |
| D1515 |
|
89 |
89 |
$37K |
| D2390 |
|
73 |
38 |
$26K |
| D9248 |
|
810 |
796 |
$24K |
| D2335 |
|
41 |
39 |
$17K |
| D9310 |
|
182 |
182 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
100 |
100 |
$2K |