| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,502 |
12,441 |
$613K |
| D0120 |
Periodic oral evaluation - established patient |
6,101 |
6,086 |
$418K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,978 |
1,324 |
$353K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,358 |
5,314 |
$351K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,869 |
2,986 |
$321K |
| D1310 |
|
6,319 |
6,288 |
$276K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,536 |
12,463 |
$251K |
| D1351 |
Sealant - per tooth |
5,769 |
2,081 |
$217K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,728 |
4,345 |
$188K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,852 |
1,059 |
$182K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,168 |
1,914 |
$179K |
| D0230 |
Intraoral - periapical each additional radiographic image |
42,395 |
10,247 |
$172K |
| D0350 |
|
23,305 |
9,146 |
$172K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,861 |
1,325 |
$101K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,340 |
1,335 |
$89K |
| D0603 |
|
5,395 |
5,373 |
$77K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
912 |
731 |
$72K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
273 |
142 |
$70K |
| D0274 |
Bitewings - four radiographic images |
3,156 |
3,138 |
$60K |
| D0272 |
Bitewings - two radiographic images |
3,905 |
3,881 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
3,345 |
3,291 |
$40K |
| D9430 |
|
942 |
916 |
$30K |
| D1510 |
|
92 |
79 |
$19K |
| D9222 |
|
142 |
142 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
146 |
146 |
$7K |
| D0601 |
|
474 |
469 |
$7K |
| D0330 |
Panoramic radiographic image |
234 |
227 |
$7K |
| D2330 |
|
45 |
25 |
$4K |
| D3230 |
|
23 |
12 |
$2K |
| D9993 |
|
35 |
35 |
$2K |
| D0602 |
|
28 |
28 |
$405.00 |