| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
25,755 |
25,693 |
$1.47M |
| D1120 |
Prophylaxis - child |
31,636 |
31,534 |
$1.30M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,735 |
1,848 |
$910K |
| D0230 |
Intraoral - periapical each additional radiographic image |
129,322 |
27,885 |
$548K |
| D1206 |
Topical application of fluoride varnish |
31,236 |
31,122 |
$485K |
| D1310 |
|
10,567 |
10,536 |
$472K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,673 |
3,114 |
$375K |
| D1351 |
Sealant - per tooth |
11,415 |
3,399 |
$329K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,667 |
4,651 |
$304K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
824 |
363 |
$272K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,686 |
2,285 |
$240K |
| D9993 |
|
3,573 |
3,562 |
$221K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,710 |
2,135 |
$196K |
| D0272 |
Bitewings - two radiographic images |
16,553 |
16,484 |
$193K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,010 |
3,860 |
$158K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,450 |
2,446 |
$156K |
| D0274 |
Bitewings - four radiographic images |
6,612 |
6,588 |
$140K |
| D0603 |
|
8,280 |
8,257 |
$120K |
| D0220 |
Intraoral - periapical first radiographic image |
7,053 |
6,956 |
$82K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
633 |
328 |
$62K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
740 |
451 |
$49K |
| D9222 |
|
366 |
363 |
$45K |
| D9610 |
|
574 |
395 |
$33K |
| D0330 |
Panoramic radiographic image |
966 |
959 |
$29K |
| D0350 |
|
3,339 |
2,769 |
$28K |
| D0602 |
|
1,744 |
1,743 |
$26K |
| D9221 |
|
53 |
32 |
$20K |
| D9920 |
|
72 |
72 |
$10K |
| D9430 |
|
300 |
297 |
$10K |
| D2932 |
|
86 |
24 |
$9K |
| D1510 |
|
37 |
25 |
$8K |
| D9220 |
|
32 |
32 |
$8K |
| D2335 |
|
57 |
13 |
$7K |
| D1354 |
|
320 |
197 |
$6K |
| D2330 |
|
56 |
37 |
$4K |
| D1320 |
|
284 |
283 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
81 |
81 |
$2K |
| D9420 |
|
56 |
56 |
$2K |
| D7111 |
|
16 |
12 |
$918.40 |
| D0601 |
|
12 |
12 |
$161.25 |