| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
21,224 |
21,155 |
$1.31M |
| D1120 |
Prophylaxis - child |
28,095 |
28,007 |
$1.17M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,617 |
3,944 |
$580K |
| D1206 |
Topical application of fluoride varnish |
27,155 |
27,069 |
$427K |
| D1310 |
|
8,643 |
8,613 |
$389K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,117 |
5,100 |
$333K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,193 |
2,602 |
$298K |
| D1351 |
Sealant - per tooth |
8,941 |
2,988 |
$254K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,298 |
5,832 |
$249K |
| D9993 |
|
4,773 |
4,769 |
$249K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,403 |
659 |
$167K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,520 |
2,511 |
$158K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,628 |
1,699 |
$143K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,465 |
14,149 |
$126K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,546 |
1,032 |
$123K |
| D0272 |
Bitewings - two radiographic images |
9,967 |
9,924 |
$117K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,182 |
547 |
$117K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
241 |
115 |
$105K |
| D0350 |
|
9,324 |
3,732 |
$92K |
| D0603 |
|
4,645 |
4,636 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,231 |
2,222 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
3,932 |
3,845 |
$47K |
| D9430 |
|
1,352 |
1,330 |
$43K |
| D0601 |
|
2,140 |
2,125 |
$32K |
| D2330 |
|
406 |
207 |
$31K |
| D0330 |
Panoramic radiographic image |
663 |
662 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
363 |
360 |
$15K |
| D0602 |
|
988 |
988 |
$15K |
| D9222 |
|
115 |
115 |
$14K |
| D9610 |
|
263 |
116 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
125 |
123 |
$4K |
| D1999 |
|
6,900 |
6,637 |
$1K |
| D9310 |
|
14 |
12 |
$550.00 |
| D0270 |
|
74 |
73 |
$370.00 |