| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
35,203 |
34,982 |
$2.03M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
20,101 |
6,009 |
$1.98M |
| D1120 |
Prophylaxis - child |
43,338 |
43,014 |
$1.73M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
6,623 |
2,504 |
$1.30M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19,281 |
7,688 |
$1.29M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,268 |
3,599 |
$1.22M |
| D0230 |
Intraoral - periapical each additional radiographic image |
267,694 |
52,872 |
$1.12M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,445 |
10,396 |
$669K |
| D2140 |
|
11,755 |
5,333 |
$639K |
| D1208 |
Topical application of fluoride, excluding varnish |
43,353 |
43,027 |
$551K |
| D1351 |
Sealant - per tooth |
16,747 |
3,497 |
$494K |
| D9221 |
|
1,491 |
1,386 |
$469K |
| D0272 |
Bitewings - two radiographic images |
36,340 |
36,112 |
$429K |
| D2330 |
|
5,130 |
2,405 |
$390K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,696 |
3,244 |
$383K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,571 |
8,227 |
$335K |
| D0350 |
|
28,975 |
15,672 |
$314K |
| D9220 |
|
1,453 |
1,450 |
$310K |
| D9222 |
|
2,499 |
2,495 |
$305K |
| D0220 |
Intraoral - periapical first radiographic image |
25,385 |
24,364 |
$299K |
| D1310 |
|
6,038 |
5,959 |
$265K |
| D9430 |
|
6,336 |
6,122 |
$198K |
| D1510 |
|
1,257 |
941 |
$197K |
| D1110 |
Prophylaxis - adult |
2,067 |
2,058 |
$178K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,980 |
1,435 |
$162K |
| D2335 |
|
1,251 |
538 |
$147K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,713 |
1,691 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,400 |
702 |
$94K |
| D2331 |
|
1,117 |
675 |
$90K |
| D2160 |
|
979 |
732 |
$78K |
| D0603 |
|
3,885 |
3,826 |
$55K |
| D2332 |
|
422 |
242 |
$35K |
| D0601 |
|
1,912 |
1,898 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
53 |
39 |
$4K |
| D2931 |
|
30 |
26 |
$4K |
| D0602 |
|
127 |
127 |
$2K |
| D3222 |
|
17 |
14 |
$2K |
| D0270 |
|
12 |
12 |
$60.00 |
| D9993 |
|
606 |
605 |
$0.00 |