| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
53,844 |
11,359 |
$912K |
| D1120 |
Prophylaxis - child |
35,512 |
35,328 |
$904K |
| D0120 |
Periodic oral evaluation - established patient |
29,530 |
29,375 |
$635K |
| D1206 |
Topical application of fluoride varnish |
38,797 |
38,607 |
$550K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,941 |
5,973 |
$445K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,855 |
1,866 |
$422K |
| D0210 |
Intraoral - complete series of radiographic images |
5,240 |
5,234 |
$245K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,434 |
7,391 |
$215K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,990 |
2,851 |
$191K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,462 |
3,192 |
$174K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,728 |
1,586 |
$171K |
| D9420 |
|
443 |
437 |
$138K |
| D0272 |
Bitewings - two radiographic images |
15,973 |
15,868 |
$117K |
| D0140 |
Limited oral evaluation - problem focused |
3,377 |
3,332 |
$92K |
| D0603 |
|
13,179 |
13,092 |
$85K |
| D9920 |
|
4,310 |
4,167 |
$81K |
| D0602 |
|
12,102 |
12,044 |
$79K |
| D0274 |
Bitewings - four radiographic images |
7,241 |
7,199 |
$60K |
| D1110 |
Prophylaxis - adult |
1,832 |
1,829 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
8,886 |
8,713 |
$44K |
| D0330 |
Panoramic radiographic image |
4,576 |
4,557 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
678 |
566 |
$37K |
| D0601 |
|
4,897 |
4,871 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,653 |
6,768 |
$23K |
| D1510 |
|
81 |
70 |
$8K |
| D7111 |
|
157 |
122 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
450 |
431 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
50 |
31 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
120 |
120 |
$475.02 |
| D1208 |
Topical application of fluoride, excluding varnish |
205 |
205 |
$450.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
292 |
288 |
$286.00 |
| D0270 |
|
25 |
24 |
$36.75 |
| D1330 |
|
33 |
32 |
$0.00 |
| D1999 |
|
6,187 |
5,820 |
$0.00 |