| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
31,614 |
31,480 |
$1.84M |
| D1120 |
Prophylaxis - child |
44,857 |
44,715 |
$1.75M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27,626 |
26,691 |
$1.09M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,111 |
6,549 |
$1.06M |
| D0230 |
Intraoral - periapical each additional radiographic image |
233,601 |
43,556 |
$944K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,064 |
8,616 |
$843K |
| D1351 |
Sealant - per tooth |
26,683 |
9,921 |
$745K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,741 |
11,717 |
$743K |
| D1310 |
|
15,886 |
15,798 |
$716K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,250 |
5,080 |
$708K |
| D7140 |
Extraction, erupted tooth or exposed root |
12,430 |
8,068 |
$693K |
| D1208 |
Topical application of fluoride, excluding varnish |
44,448 |
44,308 |
$634K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
8,428 |
5,112 |
$562K |
| D0350 |
|
57,504 |
21,156 |
$527K |
| D9993 |
|
7,003 |
6,988 |
$413K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,393 |
4,771 |
$330K |
| D0272 |
Bitewings - two radiographic images |
27,994 |
27,892 |
$326K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,541 |
4,532 |
$279K |
| D2330 |
|
2,488 |
1,606 |
$184K |
| D2140 |
|
2,901 |
2,000 |
$156K |
| D0603 |
|
8,889 |
8,843 |
$131K |
| D0274 |
Bitewings - four radiographic images |
5,716 |
5,699 |
$116K |
| D0220 |
Intraoral - periapical first radiographic image |
9,234 |
9,184 |
$108K |
| D1510 |
|
570 |
530 |
$81K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
994 |
889 |
$75K |
| D2335 |
|
581 |
428 |
$65K |
| D0601 |
|
4,314 |
4,296 |
$64K |
| D9430 |
|
964 |
946 |
$31K |
| D0602 |
|
2,061 |
2,040 |
$30K |
| D2160 |
|
339 |
300 |
$27K |
| D2332 |
|
343 |
275 |
$26K |
| D1354 |
|
148 |
98 |
$3K |
| D1330 |
|
18,626 |
18,618 |
$0.00 |