| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
27,467 |
27,330 |
$1.57M |
| D1120 |
Prophylaxis - child |
34,907 |
34,737 |
$1.40M |
| D1310 |
|
16,248 |
16,120 |
$728K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,306 |
2,949 |
$627K |
| D0350 |
|
81,276 |
28,260 |
$613K |
| D1208 |
Topical application of fluoride, excluding varnish |
34,315 |
34,147 |
$542K |
| D9993 |
|
8,443 |
8,438 |
$538K |
| D0230 |
Intraoral - periapical each additional radiographic image |
113,094 |
27,875 |
$478K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,398 |
4,646 |
$423K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,488 |
9,823 |
$413K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,406 |
2,194 |
$335K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,870 |
4,857 |
$312K |
| D1351 |
Sealant - per tooth |
10,389 |
3,009 |
$298K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,392 |
2,746 |
$247K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,524 |
3,502 |
$220K |
| D0603 |
|
14,289 |
14,173 |
$209K |
| D0274 |
Bitewings - four radiographic images |
8,522 |
8,498 |
$168K |
| D0220 |
Intraoral - periapical first radiographic image |
11,255 |
11,113 |
$131K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,284 |
1,701 |
$121K |
| D0272 |
Bitewings - two radiographic images |
8,969 |
8,937 |
$105K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,035 |
906 |
$81K |
| D9430 |
|
2,050 |
2,016 |
$65K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
210 |
140 |
$61K |
| D0330 |
Panoramic radiographic image |
2,046 |
2,039 |
$59K |
| D0210 |
Intraoral - complete series of radiographic images |
368 |
368 |
$18K |
| D9222 |
|
140 |
140 |
$17K |
| D0602 |
|
1,090 |
1,084 |
$16K |
| D2330 |
|
134 |
78 |
$10K |
| D1510 |
|
52 |
49 |
$7K |
| D2940 |
|
284 |
242 |
$6K |
| D2332 |
|
19 |
12 |
$2K |
| D0601 |
|
59 |
59 |
$630.00 |
| D1354 |
|
31 |
15 |
$372.00 |
| D0270 |
|
29 |
29 |
$145.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
736 |
722 |
$0.00 |
| D9996 |
|
226 |
225 |
$0.00 |