| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
66,457 |
66,176 |
$3.71M |
| D1120 |
Prophylaxis - child |
92,752 |
92,316 |
$3.57M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
37,912 |
19,211 |
$2.44M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16,959 |
8,765 |
$1.95M |
| D1351 |
Sealant - per tooth |
58,556 |
17,207 |
$1.62M |
| D1310 |
|
29,244 |
29,146 |
$1.31M |
| D1208 |
Topical application of fluoride, excluding varnish |
84,680 |
84,292 |
$1.22M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17,014 |
16,970 |
$1.08M |
| D0230 |
Intraoral - periapical each additional radiographic image |
236,269 |
74,475 |
$977K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
24,037 |
23,424 |
$940K |
| D9993 |
|
13,674 |
13,666 |
$879K |
| D7140 |
Extraction, erupted tooth or exposed root |
15,448 |
8,795 |
$847K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13,377 |
8,586 |
$692K |
| D0274 |
Bitewings - four radiographic images |
28,889 |
28,743 |
$559K |
| D0145 |
Oral evaluation for a patient under three years of age |
6,794 |
6,785 |
$412K |
| D0272 |
Bitewings - two radiographic images |
35,719 |
35,556 |
$382K |
| D0220 |
Intraoral - periapical first radiographic image |
29,983 |
29,656 |
$341K |
| D3240 |
|
3,535 |
2,213 |
$339K |
| D0350 |
|
28,464 |
16,945 |
$288K |
| D0603 |
|
19,456 |
19,380 |
$284K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,346 |
2,363 |
$255K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
350 |
339 |
$252K |
| D9430 |
|
5,240 |
5,165 |
$164K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,040 |
621 |
$102K |
| D0330 |
Panoramic radiographic image |
3,534 |
3,528 |
$101K |
| D2330 |
|
1,304 |
839 |
$95K |
| D2932 |
|
808 |
388 |
$83K |
| D0601 |
|
3,601 |
3,585 |
$51K |
| D1510 |
|
292 |
260 |
$44K |
| D0602 |
|
2,871 |
2,871 |
$42K |
| D9222 |
|
340 |
338 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
651 |
632 |
$28K |
| D9610 |
|
324 |
315 |
$26K |
| D2332 |
|
180 |
126 |
$14K |
| D1206 |
Topical application of fluoride varnish |
1,744 |
1,729 |
$10K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
12 |
$7K |
| D9920 |
|
98 |
98 |
$4K |
| D3230 |
|
29 |
14 |
$3K |
| D1999 |
|
680 |
665 |
$1K |
| D0270 |
|
232 |
228 |
$1K |
| D2331 |
|
14 |
14 |
$588.00 |
| D1330 |
|
328 |
326 |
$0.00 |
| D9215 |
|
14 |
14 |
$0.00 |