| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
32,555 |
32,343 |
$2.18M |
| D1120 |
Prophylaxis - child |
46,224 |
45,956 |
$2.02M |
| D1310 |
|
21,374 |
21,225 |
$969K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,709 |
11,675 |
$777K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,199 |
6,477 |
$733K |
| D1351 |
Sealant - per tooth |
21,709 |
6,494 |
$693K |
| D1206 |
Topical application of fluoride varnish |
41,498 |
41,287 |
$660K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,692 |
5,196 |
$541K |
| D9993 |
|
8,339 |
8,331 |
$536K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,902 |
2,541 |
$454K |
| D9430 |
|
13,767 |
12,732 |
$438K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,815 |
11,424 |
$365K |
| D0603 |
|
21,307 |
21,157 |
$314K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,573 |
3,942 |
$297K |
| D0230 |
Intraoral - periapical each additional radiographic image |
72,454 |
28,298 |
$282K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,119 |
4,091 |
$277K |
| D0350 |
|
23,816 |
13,332 |
$223K |
| D2335 |
|
1,911 |
1,325 |
$223K |
| D0272 |
Bitewings - two radiographic images |
18,720 |
18,611 |
$218K |
| D0220 |
Intraoral - periapical first radiographic image |
15,858 |
15,221 |
$186K |
| D0330 |
Panoramic radiographic image |
5,916 |
5,889 |
$162K |
| D0274 |
Bitewings - four radiographic images |
7,635 |
7,607 |
$160K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,287 |
1,098 |
$101K |
| D0210 |
Intraoral - complete series of radiographic images |
2,074 |
2,064 |
$97K |
| D9248 |
|
2,654 |
2,569 |
$92K |
| D0140 |
Limited oral evaluation - problem focused |
2,663 |
2,657 |
$91K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,248 |
4,193 |
$90K |
| D9920 |
|
830 |
817 |
$79K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
620 |
394 |
$61K |
| D0340 |
|
560 |
560 |
$28K |
| D1510 |
|
190 |
178 |
$27K |
| D8670 |
Periodic orthodontic treatment visit |
78 |
78 |
$23K |
| D2330 |
|
175 |
123 |
$13K |
| D1517 |
|
59 |
59 |
$11K |
| D1320 |
|
334 |
334 |
$6K |
| D1354 |
|
296 |
130 |
$4K |
| D0999 |
Unspecified diagnostic procedure, by report |
51 |
47 |
$1K |
| D9995 |
|
561 |
496 |
$1K |
| D0470 |
|
14 |
14 |
$1K |
| D1999 |
|
577 |
558 |
$704.00 |
| D0601 |
|
40 |
40 |
$596.25 |
| D0190 |
|
246 |
229 |
$0.00 |
| D9996 |
|
44 |
38 |
$0.00 |