| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
87,545 |
87,505 |
$3.06M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22,121 |
15,408 |
$2.31M |
| D0120 |
Periodic oral evaluation - established patient |
89,899 |
89,843 |
$2.11M |
| D1110 |
Prophylaxis - adult |
34,235 |
34,212 |
$1.73M |
| D1206 |
Topical application of fluoride varnish |
104,680 |
104,621 |
$1.72M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17,233 |
11,632 |
$1.52M |
| D0272 |
Bitewings - two radiographic images |
57,509 |
57,481 |
$1.09M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
25,507 |
25,502 |
$1.04M |
| D0274 |
Bitewings - four radiographic images |
31,319 |
31,297 |
$866K |
| D0330 |
Panoramic radiographic image |
16,732 |
16,729 |
$786K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,298 |
5,146 |
$708K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17,461 |
16,631 |
$568K |
| D1351 |
Sealant - per tooth |
13,527 |
4,320 |
$409K |
| D0140 |
Limited oral evaluation - problem focused |
9,506 |
9,444 |
$362K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,472 |
1,734 |
$321K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,864 |
5,861 |
$271K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,476 |
15,476 |
$252K |
| D0220 |
Intraoral - periapical first radiographic image |
18,759 |
18,636 |
$241K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,861 |
1,521 |
$240K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,262 |
747 |
$176K |
| D0240 |
|
8,194 |
4,463 |
$150K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
265 |
242 |
$143K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,517 |
8,840 |
$115K |
| D7240 |
Removal of impacted tooth - completely bony |
346 |
110 |
$96K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
767 |
616 |
$64K |
| D2330 |
|
626 |
371 |
$61K |
| D2950 |
|
493 |
402 |
$60K |
| D7111 |
|
722 |
507 |
$48K |
| D9248 |
|
497 |
485 |
$37K |
| D9920 |
|
604 |
574 |
$36K |
| D7230 |
|
77 |
44 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
342 |
342 |
$17K |
| D2331 |
|
135 |
83 |
$15K |
| D2954 |
|
51 |
42 |
$8K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
59 |
59 |
$5K |
| D9222 |
|
59 |
59 |
$5K |
| D7250 |
|
21 |
14 |
$3K |
| D2940 |
|
30 |
25 |
$1K |