| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
59,170 |
59,088 |
$3.52M |
| D1120 |
Prophylaxis - child |
88,283 |
88,151 |
$3.50M |
| D1206 |
Topical application of fluoride varnish |
86,604 |
86,464 |
$1.29M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
19,661 |
19,649 |
$1.26M |
| D1310 |
|
28,001 |
27,921 |
$1.26M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,666 |
1,073 |
$1.13M |
| D0230 |
Intraoral - periapical each additional radiographic image |
214,985 |
64,915 |
$868K |
| D9993 |
|
12,067 |
12,059 |
$762K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,796 |
6,829 |
$655K |
| D1351 |
Sealant - per tooth |
20,177 |
7,972 |
$526K |
| D0272 |
Bitewings - two radiographic images |
42,933 |
42,884 |
$496K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,105 |
1,384 |
$485K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,614 |
11,415 |
$456K |
| D0603 |
|
27,463 |
27,388 |
$403K |
| D9221 |
|
796 |
602 |
$387K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,609 |
4,604 |
$301K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,004 |
1,920 |
$285K |
| D0274 |
Bitewings - four radiographic images |
12,914 |
12,907 |
$273K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,399 |
3,313 |
$238K |
| D0350 |
|
14,278 |
8,821 |
$140K |
| D9610 |
|
1,827 |
1,652 |
$138K |
| D9222 |
|
1,072 |
1,069 |
$131K |
| D9220 |
|
603 |
602 |
$130K |
| D9430 |
|
4,076 |
4,045 |
$129K |
| D0220 |
Intraoral - periapical first radiographic image |
5,230 |
5,202 |
$61K |
| D9920 |
|
271 |
271 |
$36K |
| D0330 |
Panoramic radiographic image |
773 |
772 |
$23K |
| D1354 |
|
1,845 |
668 |
$22K |
| D2940 |
|
142 |
59 |
$7K |
| D2330 |
|
73 |
37 |
$6K |
| D9420 |
|
24 |
24 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
48 |
48 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
26 |
$2K |
| D9995 |
|
503 |
498 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
117 |
117 |
$320.64 |
| D0270 |
|
39 |
39 |
$195.00 |
| D0602 |
|
12 |
12 |
$180.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
17,885 |
10,703 |
$0.02 |
| D1330 |
|
84,591 |
84,401 |
$0.00 |