| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
42,806 |
42,653 |
$2.61M |
| D1120 |
Prophylaxis - child |
57,043 |
56,821 |
$2.42M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,750 |
9,396 |
$1.17M |
| D1310 |
|
23,165 |
23,060 |
$1.06M |
| D1208 |
Topical application of fluoride, excluding varnish |
42,645 |
42,457 |
$739K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
18,190 |
17,464 |
$721K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,667 |
9,633 |
$620K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,013 |
3,069 |
$592K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,650 |
5,535 |
$545K |
| D0230 |
Intraoral - periapical each additional radiographic image |
128,785 |
50,352 |
$533K |
| D9993 |
|
7,999 |
7,983 |
$513K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,460 |
2,677 |
$438K |
| D0272 |
Bitewings - two radiographic images |
36,299 |
36,150 |
$423K |
| D1351 |
Sealant - per tooth |
13,190 |
3,906 |
$415K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,620 |
4,139 |
$351K |
| D0603 |
|
18,406 |
18,317 |
$274K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,156 |
4,135 |
$260K |
| D1206 |
Topical application of fluoride varnish |
12,836 |
12,810 |
$168K |
| D0220 |
Intraoral - periapical first radiographic image |
13,870 |
13,676 |
$164K |
| D9430 |
|
4,506 |
4,358 |
$142K |
| D0340 |
|
2,647 |
2,635 |
$130K |
| D0350 |
|
11,856 |
6,970 |
$121K |
| D0140 |
Limited oral evaluation - problem focused |
2,689 |
2,680 |
$92K |
| D0330 |
Panoramic radiographic image |
2,640 |
2,629 |
$78K |
| D0274 |
Bitewings - four radiographic images |
3,158 |
3,158 |
$66K |
| D2330 |
|
815 |
476 |
$61K |
| D1510 |
|
277 |
239 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
570 |
444 |
$45K |
| D0601 |
|
1,995 |
1,993 |
$30K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
120 |
25 |
$23K |
| D8670 |
Periodic orthodontic treatment visit |
69 |
69 |
$20K |
| D1352 |
|
305 |
113 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
231 |
231 |
$10K |
| D0602 |
|
586 |
586 |
$9K |
| D9222 |
|
25 |
25 |
$3K |
| D9610 |
|
71 |
25 |
$2K |
| D0270 |
|
361 |
359 |
$2K |
| D1999 |
|
2,628 |
2,574 |
$695.00 |
| D1330 |
|
12 |
12 |
$0.00 |