| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
34,055 |
33,907 |
$2.05M |
| D1120 |
Prophylaxis - child |
46,252 |
46,061 |
$1.96M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,754 |
6,881 |
$789K |
| D1206 |
Topical application of fluoride varnish |
45,504 |
45,318 |
$750K |
| D1310 |
|
15,218 |
15,152 |
$693K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,428 |
10,398 |
$672K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15,783 |
14,935 |
$625K |
| D0230 |
Intraoral - periapical each additional radiographic image |
154,491 |
41,485 |
$621K |
| D1351 |
Sealant - per tooth |
12,141 |
3,611 |
$417K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,280 |
2,756 |
$390K |
| D0272 |
Bitewings - two radiographic images |
31,493 |
31,363 |
$372K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,376 |
4,533 |
$364K |
| D9993 |
|
5,864 |
5,862 |
$364K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,931 |
3,915 |
$248K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,289 |
1,943 |
$227K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,739 |
2,104 |
$149K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,976 |
1,234 |
$133K |
| D0603 |
|
8,000 |
7,955 |
$119K |
| D0220 |
Intraoral - periapical first radiographic image |
8,446 |
8,337 |
$99K |
| D0601 |
|
5,939 |
5,909 |
$88K |
| D0274 |
Bitewings - four radiographic images |
3,909 |
3,887 |
$84K |
| D9430 |
|
2,558 |
2,524 |
$81K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
428 |
378 |
$34K |
| D2140 |
|
504 |
397 |
$27K |
| D0350 |
|
2,854 |
2,219 |
$21K |
| D0602 |
|
622 |
621 |
$9K |
| D1510 |
|
30 |
27 |
$6K |
| D2330 |
|
62 |
39 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
51 |
51 |
$730.00 |