| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
81,316 |
81,092 |
$4.74M |
| D1120 |
Prophylaxis - child |
94,923 |
94,640 |
$3.80M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
29,651 |
11,413 |
$3.50M |
| D0350 |
|
280,743 |
86,258 |
$2.46M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
20,248 |
9,177 |
$1.96M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
26,164 |
17,152 |
$1.72M |
| D1351 |
Sealant - per tooth |
56,804 |
16,731 |
$1.67M |
| D0230 |
Intraoral - periapical each additional radiographic image |
360,631 |
94,385 |
$1.46M |
| D1208 |
Topical application of fluoride, excluding varnish |
94,040 |
93,770 |
$1.34M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,612 |
13,579 |
$883K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
21,844 |
20,364 |
$856K |
| D7140 |
Extraction, erupted tooth or exposed root |
15,180 |
8,497 |
$849K |
| D0274 |
Bitewings - four radiographic images |
37,134 |
37,034 |
$779K |
| D1310 |
|
14,871 |
14,754 |
$669K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,301 |
8,106 |
$599K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,843 |
1,183 |
$517K |
| D0145 |
Oral evaluation for a patient under three years of age |
7,746 |
7,710 |
$491K |
| D0220 |
Intraoral - periapical first radiographic image |
40,636 |
40,034 |
$477K |
| D0272 |
Bitewings - two radiographic images |
24,535 |
24,466 |
$285K |
| D0330 |
Panoramic radiographic image |
9,527 |
9,499 |
$276K |
| D1510 |
|
1,641 |
1,318 |
$266K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,152 |
2,667 |
$245K |
| D3230 |
|
2,291 |
788 |
$220K |
| D9430 |
|
5,657 |
5,609 |
$180K |
| D9222 |
|
1,198 |
1,182 |
$149K |
| D2330 |
|
1,634 |
1,139 |
$124K |
| D0603 |
|
7,576 |
7,520 |
$112K |
| D0602 |
|
5,764 |
5,713 |
$83K |
| D2332 |
|
573 |
368 |
$45K |
| D7111 |
|
337 |
221 |
$19K |
| D2940 |
|
1,508 |
821 |
$18K |
| D0601 |
|
1,019 |
1,017 |
$15K |
| D9920 |
|
434 |
426 |
$3K |
| D0270 |
|
37 |
37 |
$185.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
83 |
83 |
$0.00 |