| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
23,991 |
23,927 |
$1.35M |
| D1120 |
Prophylaxis - child |
32,942 |
32,848 |
$1.27M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,764 |
2,038 |
$672K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,711 |
5,313 |
$630K |
| D1310 |
|
9,853 |
9,826 |
$443K |
| D1208 |
Topical application of fluoride, excluding varnish |
30,915 |
30,824 |
$443K |
| D1351 |
Sealant - per tooth |
16,769 |
5,317 |
$442K |
| D0230 |
Intraoral - periapical each additional radiographic image |
95,467 |
28,305 |
$395K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,389 |
5,381 |
$345K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,855 |
8,472 |
$341K |
| D9993 |
|
4,907 |
4,906 |
$315K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,417 |
2,433 |
$247K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,572 |
2,280 |
$188K |
| D0274 |
Bitewings - four radiographic images |
9,228 |
9,207 |
$180K |
| D0272 |
Bitewings - two radiographic images |
10,670 |
10,637 |
$118K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
191 |
176 |
$118K |
| D0603 |
|
7,094 |
7,074 |
$105K |
| D0220 |
Intraoral - periapical first radiographic image |
9,097 |
8,910 |
$105K |
| D0350 |
|
9,333 |
5,292 |
$90K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,427 |
1,423 |
$82K |
| D0210 |
Intraoral - complete series of radiographic images |
1,188 |
1,187 |
$52K |
| D9430 |
|
1,145 |
1,134 |
$36K |
| D9222 |
|
175 |
175 |
$21K |
| D3240 |
|
216 |
119 |
$21K |
| D0330 |
Panoramic radiographic image |
739 |
738 |
$19K |
| D9610 |
|
217 |
210 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
206 |
151 |
$16K |
| D9221 |
|
33 |
29 |
$14K |
| D2330 |
|
119 |
77 |
$9K |
| D0601 |
|
634 |
633 |
$9K |
| D9220 |
|
29 |
29 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
48 |
28 |
$5K |
| D0602 |
|
273 |
273 |
$4K |
| D1510 |
|
13 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
149 |
148 |
$1K |
| D9920 |
|
13 |
13 |
$1K |
| D9215 |
|
113 |
110 |
$0.00 |
| D1330 |
|
12 |
12 |
$0.00 |