| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
114,882 |
114,340 |
$6.79M |
| D1120 |
Prophylaxis - child |
151,581 |
150,854 |
$6.13M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
64,771 |
43,197 |
$4.20M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48,816 |
29,780 |
$2.55M |
| D0230 |
Intraoral - periapical each additional radiographic image |
550,872 |
145,730 |
$2.22M |
| D1206 |
Topical application of fluoride varnish |
150,616 |
149,875 |
$2.19M |
| D1351 |
Sealant - per tooth |
61,634 |
23,734 |
$1.78M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
42,042 |
39,688 |
$1.66M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
25,019 |
24,924 |
$1.62M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,606 |
8,132 |
$1.46M |
| D1310 |
|
29,432 |
29,270 |
$1.33M |
| D7140 |
Extraction, erupted tooth or exposed root |
22,724 |
14,876 |
$1.26M |
| D0274 |
Bitewings - four radiographic images |
48,581 |
48,377 |
$1.02M |
| D0350 |
|
101,441 |
52,322 |
$1.00M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
9,166 |
5,987 |
$885K |
| D0272 |
Bitewings - two radiographic images |
69,914 |
69,566 |
$807K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
10,284 |
8,595 |
$797K |
| D9430 |
|
22,476 |
21,628 |
$709K |
| D0145 |
Oral evaluation for a patient under three years of age |
9,287 |
9,267 |
$610K |
| D9993 |
|
6,412 |
6,399 |
$400K |
| D0220 |
Intraoral - periapical first radiographic image |
29,855 |
29,093 |
$348K |
| D0603 |
|
19,653 |
19,524 |
$289K |
| D2330 |
|
3,669 |
2,513 |
$277K |
| D8670 |
Periodic orthodontic treatment visit |
629 |
629 |
$179K |
| D0140 |
Limited oral evaluation - problem focused |
4,359 |
4,353 |
$151K |
| D0330 |
Panoramic radiographic image |
2,977 |
2,977 |
$86K |
| D1510 |
|
473 |
453 |
$84K |
| D0270 |
|
13,101 |
12,913 |
$65K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
251 |
109 |
$49K |
| D0601 |
|
2,848 |
2,839 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
760 |
757 |
$35K |
| D0602 |
|
2,327 |
2,320 |
$34K |
| D2332 |
|
262 |
223 |
$20K |
| D2932 |
|
133 |
66 |
$14K |
| D9222 |
|
115 |
109 |
$13K |
| D2390 |
|
75 |
39 |
$8K |
| D9610 |
|
122 |
51 |
$4K |
| D2331 |
|
50 |
40 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
12 |
$1K |
| D1354 |
|
116 |
35 |
$1K |
| D0340 |
|
20 |
20 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
103 |
103 |
$947.00 |