| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
21,724 |
21,603 |
$1.13M |
| D1120 |
Prophylaxis - child |
25,267 |
25,141 |
$949K |
| D0350 |
|
83,529 |
30,291 |
$616K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,835 |
2,173 |
$521K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,780 |
3,845 |
$373K |
| D9993 |
|
7,042 |
6,829 |
$359K |
| D0230 |
Intraoral - periapical each additional radiographic image |
76,922 |
26,147 |
$355K |
| D1310 |
|
9,411 |
9,164 |
$355K |
| D1351 |
Sealant - per tooth |
12,798 |
4,270 |
$349K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,039 |
8,124 |
$340K |
| D1208 |
Topical application of fluoride, excluding varnish |
25,231 |
25,105 |
$332K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,150 |
1,588 |
$289K |
| D0274 |
Bitewings - four radiographic images |
13,116 |
13,065 |
$264K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,806 |
2,275 |
$206K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,557 |
2,550 |
$161K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,758 |
2,045 |
$145K |
| D0272 |
Bitewings - two radiographic images |
7,323 |
7,305 |
$84K |
| D0220 |
Intraoral - periapical first radiographic image |
7,261 |
7,034 |
$80K |
| D0603 |
|
6,830 |
6,640 |
$79K |
| D9310 |
|
2,410 |
2,318 |
$73K |
| D0330 |
Panoramic radiographic image |
2,251 |
2,233 |
$63K |
| D0145 |
Oral evaluation for a patient under three years of age |
713 |
712 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
362 |
293 |
$28K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
87 |
54 |
$25K |
| D2940 |
|
946 |
414 |
$21K |
| D9430 |
|
575 |
564 |
$18K |
| D0602 |
|
1,223 |
1,205 |
$17K |
| D1510 |
|
61 |
53 |
$8K |
| D9222 |
|
54 |
54 |
$7K |
| D2330 |
|
67 |
40 |
$5K |
| D0601 |
|
65 |
65 |
$956.25 |
| D0999 |
Unspecified diagnostic procedure, by report |
649 |
646 |
$322.00 |
| D9996 |
|
98 |
98 |
$0.00 |