| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
28,203 |
28,114 |
$1.60M |
| D1120 |
Prophylaxis - child |
33,360 |
33,159 |
$1.30M |
| D0230 |
Intraoral - periapical each additional radiographic image |
219,907 |
32,406 |
$895K |
| D1351 |
Sealant - per tooth |
21,926 |
4,850 |
$660K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,531 |
4,359 |
$499K |
| D1208 |
Topical application of fluoride, excluding varnish |
33,370 |
33,168 |
$437K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,609 |
9,205 |
$376K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,475 |
1,352 |
$342K |
| D0274 |
Bitewings - four radiographic images |
15,737 |
15,673 |
$337K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,262 |
2,709 |
$243K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,764 |
937 |
$207K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,702 |
2,420 |
$196K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,826 |
2,815 |
$179K |
| D0272 |
Bitewings - two radiographic images |
13,217 |
13,117 |
$154K |
| D1310 |
|
2,233 |
2,211 |
$101K |
| D0220 |
Intraoral - periapical first radiographic image |
6,933 |
6,709 |
$81K |
| D0145 |
Oral evaluation for a patient under three years of age |
972 |
972 |
$60K |
| D8670 |
Periodic orthodontic treatment visit |
163 |
163 |
$48K |
| D9430 |
|
1,090 |
1,052 |
$34K |
| D0350 |
|
2,982 |
1,868 |
$28K |
| D2330 |
|
246 |
138 |
$19K |
| D0603 |
|
1,064 |
1,053 |
$16K |
| D0602 |
|
296 |
293 |
$4K |
| D0601 |
|
272 |
272 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
12 |
$2K |