| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
17,234 |
17,137 |
$1.04M |
| D1120 |
Prophylaxis - child |
24,309 |
24,195 |
$1.03M |
| D1310 |
|
11,589 |
11,539 |
$527K |
| D0350 |
|
57,521 |
17,502 |
$435K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,842 |
23,730 |
$404K |
| D0230 |
Intraoral - periapical each additional radiographic image |
80,648 |
19,713 |
$326K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,738 |
1,362 |
$324K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,774 |
4,753 |
$310K |
| D9993 |
|
4,830 |
4,827 |
$309K |
| D1351 |
Sealant - per tooth |
9,179 |
2,620 |
$279K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,980 |
5,447 |
$236K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,926 |
2,141 |
$192K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,875 |
2,871 |
$182K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,832 |
1,677 |
$160K |
| D0274 |
Bitewings - four radiographic images |
6,334 |
6,305 |
$131K |
| D0603 |
|
8,457 |
8,412 |
$125K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
335 |
182 |
$90K |
| D0220 |
Intraoral - periapical first radiographic image |
7,248 |
7,149 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,575 |
1,207 |
$84K |
| D0272 |
Bitewings - two radiographic images |
6,301 |
6,260 |
$74K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
672 |
373 |
$66K |
| D0330 |
Panoramic radiographic image |
1,872 |
1,853 |
$53K |
| D0602 |
|
2,293 |
2,291 |
$34K |
| D9430 |
|
1,060 |
1,023 |
$34K |
| D9222 |
|
179 |
179 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
260 |
214 |
$20K |
| D2330 |
|
78 |
43 |
$6K |
| D1354 |
|
438 |
180 |
$4K |
| D1510 |
|
15 |
12 |
$3K |
| D2940 |
|
95 |
48 |
$3K |
| D0601 |
|
125 |
125 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
38 |
38 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
862 |
835 |
$0.00 |
| D9996 |
|
60 |
60 |
$0.00 |