| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
29,152 |
29,041 |
$1.69M |
| D1120 |
Prophylaxis - child |
36,137 |
36,001 |
$1.46M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,959 |
4,377 |
$801K |
| D0230 |
Intraoral - periapical each additional radiographic image |
156,447 |
32,984 |
$683K |
| D1310 |
|
12,469 |
12,430 |
$565K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,486 |
1,967 |
$531K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,313 |
2,265 |
$526K |
| D1208 |
Topical application of fluoride, excluding varnish |
33,516 |
33,390 |
$510K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,896 |
3,637 |
$395K |
| D9993 |
|
6,443 |
6,441 |
$383K |
| D0272 |
Bitewings - two radiographic images |
30,134 |
30,009 |
$344K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,584 |
8,470 |
$339K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,140 |
5,131 |
$329K |
| D1351 |
Sealant - per tooth |
10,349 |
2,852 |
$311K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,436 |
2,434 |
$146K |
| D7240 |
Removal of impacted tooth - completely bony |
617 |
209 |
$142K |
| D0603 |
|
8,218 |
8,192 |
$121K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,784 |
905 |
$97K |
| D0350 |
|
5,327 |
3,075 |
$64K |
| D0602 |
|
2,782 |
2,771 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
457 |
255 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,256 |
2,235 |
$27K |
| D2330 |
|
134 |
75 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
157 |
156 |
$5K |
| D9430 |
|
79 |
79 |
$2K |
| D0601 |
|
98 |
98 |
$1K |
| D1999 |
|
195 |
193 |
$782.00 |