| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
54,705 |
54,521 |
$3.15M |
| D1120 |
Prophylaxis - child |
66,675 |
66,402 |
$2.70M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,160 |
9,204 |
$1.13M |
| D1206 |
Topical application of fluoride varnish |
62,404 |
62,164 |
$909K |
| D1310 |
|
19,876 |
19,742 |
$906K |
| D0230 |
Intraoral - periapical each additional radiographic image |
184,401 |
59,970 |
$739K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16,529 |
16,043 |
$653K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,260 |
7,233 |
$470K |
| D0272 |
Bitewings - two radiographic images |
38,904 |
38,782 |
$449K |
| D9993 |
|
6,967 |
6,955 |
$448K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,607 |
4,643 |
$426K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,444 |
1,882 |
$406K |
| D1351 |
Sealant - per tooth |
12,975 |
3,929 |
$403K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,900 |
3,822 |
$309K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,984 |
1,544 |
$291K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,615 |
3,607 |
$231K |
| D0274 |
Bitewings - four radiographic images |
10,790 |
10,747 |
$223K |
| D0603 |
|
13,765 |
13,675 |
$205K |
| D8670 |
Periodic orthodontic treatment visit |
600 |
583 |
$166K |
| D0220 |
Intraoral - periapical first radiographic image |
14,002 |
13,844 |
$164K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
334 |
195 |
$158K |
| D0340 |
|
3,114 |
3,092 |
$155K |
| D9430 |
|
3,693 |
3,608 |
$116K |
| D0140 |
Limited oral evaluation - problem focused |
3,141 |
3,126 |
$106K |
| D0350 |
|
9,702 |
6,037 |
$97K |
| D0330 |
Panoramic radiographic image |
3,120 |
3,097 |
$91K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,096 |
3,090 |
$63K |
| D0602 |
|
3,391 |
3,374 |
$50K |
| D9222 |
|
195 |
195 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
272 |
207 |
$21K |
| D9610 |
|
281 |
196 |
$16K |
| D1510 |
|
53 |
49 |
$10K |
| D2330 |
|
106 |
68 |
$8K |
| D0601 |
|
526 |
520 |
$8K |
| D1352 |
|
177 |
89 |
$4K |
| D0270 |
|
226 |
224 |
$1K |
| D9920 |
|
12 |
12 |
$840.00 |
| D9310 |
|
13 |
13 |
$650.00 |