| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
17,348 |
17,227 |
$1.02M |
| D1120 |
Prophylaxis - child |
21,753 |
21,602 |
$861K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,443 |
10,766 |
$446K |
| D0230 |
Intraoral - periapical each additional radiographic image |
109,089 |
20,961 |
$441K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,596 |
2,565 |
$411K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,263 |
4,108 |
$394K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,305 |
2,401 |
$314K |
| D1351 |
Sealant - per tooth |
9,209 |
3,113 |
$269K |
| D1310 |
|
5,880 |
5,824 |
$263K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,785 |
2,556 |
$249K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,277 |
2,964 |
$234K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,972 |
17,822 |
$220K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,297 |
3,269 |
$207K |
| D9993 |
|
2,674 |
2,653 |
$160K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,885 |
2,156 |
$149K |
| D0272 |
Bitewings - two radiographic images |
12,469 |
12,370 |
$143K |
| D2330 |
|
1,751 |
1,199 |
$128K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,731 |
1,719 |
$107K |
| D0274 |
Bitewings - four radiographic images |
4,986 |
4,952 |
$103K |
| D1206 |
Topical application of fluoride varnish |
3,611 |
3,579 |
$85K |
| D9430 |
|
1,708 |
1,625 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
4,161 |
4,014 |
$48K |
| D0603 |
|
3,265 |
3,233 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
632 |
516 |
$46K |
| D1510 |
|
263 |
255 |
$34K |
| D0601 |
|
2,300 |
2,278 |
$33K |
| D2160 |
|
352 |
314 |
$28K |
| D0350 |
|
2,412 |
1,628 |
$20K |
| D2331 |
|
254 |
207 |
$19K |
| D2140 |
|
146 |
108 |
$8K |
| D0602 |
|
69 |
68 |
$990.00 |