| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
26,489 |
26,371 |
$1.16M |
| D0120 |
Periodic oral evaluation - established patient |
16,414 |
16,338 |
$1.04M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,707 |
2,356 |
$799K |
| D1310 |
|
17,412 |
17,329 |
$791K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,037 |
7,011 |
$474K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,077 |
548 |
$460K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,928 |
3,721 |
$456K |
| D9993 |
|
6,207 |
6,193 |
$397K |
| D1206 |
Topical application of fluoride varnish |
13,210 |
13,161 |
$326K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,188 |
4,170 |
$279K |
| D1351 |
Sealant - per tooth |
8,583 |
2,785 |
$277K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,797 |
1,100 |
$275K |
| D0230 |
Intraoral - periapical each additional radiographic image |
64,609 |
20,557 |
$263K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,211 |
5,684 |
$247K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,190 |
2,113 |
$236K |
| D0603 |
|
13,592 |
13,531 |
$201K |
| D0272 |
Bitewings - two radiographic images |
14,289 |
14,215 |
$166K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,167 |
12,098 |
$161K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,749 |
1,751 |
$145K |
| D2330 |
|
1,639 |
765 |
$124K |
| D9430 |
|
3,747 |
3,605 |
$117K |
| D0350 |
|
10,340 |
4,918 |
$105K |
| D0220 |
Intraoral - periapical first radiographic image |
6,445 |
6,259 |
$76K |
| D9222 |
|
534 |
534 |
$65K |
| D0602 |
|
3,276 |
3,261 |
$49K |
| D9610 |
|
508 |
483 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,697 |
1,688 |
$36K |
| D2390 |
|
267 |
97 |
$27K |
| D1510 |
|
156 |
127 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
143 |
108 |
$11K |
| D1354 |
|
510 |
227 |
$6K |
| D2941 |
|
129 |
69 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
83 |
83 |
$4K |
| D0601 |
|
191 |
191 |
$3K |
| D2940 |
|
35 |
29 |
$2K |
| D1320 |
|
179 |
179 |
$2K |
| D9995 |
|
609 |
596 |
$394.68 |