| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
74,836 |
74,622 |
$4.25M |
| D1120 |
Prophylaxis - child |
94,192 |
93,808 |
$3.63M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
22,654 |
14,065 |
$2.64M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
56,870 |
56,173 |
$2.24M |
| D1310 |
|
41,123 |
41,015 |
$1.86M |
| D9993 |
|
22,230 |
22,203 |
$1.33M |
| D1351 |
Sealant - per tooth |
44,034 |
13,877 |
$1.24M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
11,749 |
7,722 |
$1.15M |
| D7140 |
Extraction, erupted tooth or exposed root |
20,131 |
13,193 |
$1.13M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,063 |
12,031 |
$1.07M |
| D0230 |
Intraoral - periapical each additional radiographic image |
207,970 |
82,264 |
$873K |
| D0272 |
Bitewings - two radiographic images |
71,694 |
71,424 |
$836K |
| D1208 |
Topical application of fluoride, excluding varnish |
64,697 |
64,486 |
$804K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,659 |
11,639 |
$755K |
| D1206 |
Topical application of fluoride varnish |
29,755 |
29,589 |
$672K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
9,659 |
6,632 |
$629K |
| D2335 |
|
5,260 |
3,651 |
$618K |
| D0145 |
Oral evaluation for a patient under three years of age |
8,200 |
8,190 |
$488K |
| D0603 |
|
32,171 |
32,079 |
$475K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,798 |
5,448 |
$368K |
| D2330 |
|
4,814 |
3,113 |
$365K |
| D2140 |
|
5,218 |
3,989 |
$279K |
| D9430 |
|
6,536 |
6,463 |
$205K |
| D0350 |
|
17,261 |
13,817 |
$178K |
| D0220 |
Intraoral - periapical first radiographic image |
12,001 |
11,839 |
$138K |
| D1354 |
|
5,090 |
2,612 |
$85K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
102 |
99 |
$79K |
| D0274 |
Bitewings - four radiographic images |
3,945 |
3,935 |
$78K |
| D9420 |
|
730 |
600 |
$74K |
| D0601 |
|
4,969 |
4,960 |
$74K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
588 |
540 |
$47K |
| D1510 |
|
203 |
194 |
$37K |
| D0602 |
|
1,736 |
1,735 |
$26K |
| D2160 |
|
171 |
157 |
$14K |
| D9222 |
|
99 |
99 |
$12K |
| D9610 |
|
99 |
99 |
$8K |
| D2331 |
|
66 |
53 |
$5K |
| D2940 |
|
18 |
18 |
$962.50 |
| D3120 |
|
164 |
154 |
$0.00 |