| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,303 |
11,261 |
$608K |
| D1120 |
Prophylaxis - child |
13,699 |
13,638 |
$538K |
| D1351 |
Sealant - per tooth |
7,754 |
2,144 |
$218K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,722 |
13,657 |
$203K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,538 |
632 |
$179K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,800 |
1,529 |
$160K |
| D9993 |
|
2,671 |
2,667 |
$158K |
| D1310 |
|
5,255 |
5,234 |
$130K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,201 |
503 |
$119K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
312 |
92 |
$113K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,135 |
12,262 |
$112K |
| D0274 |
Bitewings - four radiographic images |
4,666 |
4,643 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,302 |
1,298 |
$83K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,086 |
519 |
$73K |
| D0603 |
|
4,790 |
4,771 |
$71K |
| D9430 |
|
2,225 |
2,086 |
$66K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,057 |
1,056 |
$64K |
| D0272 |
Bitewings - two radiographic images |
4,645 |
4,633 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,373 |
1,322 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
4,209 |
4,058 |
$50K |
| D0340 |
|
577 |
576 |
$29K |
| D0330 |
Panoramic radiographic image |
603 |
602 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
472 |
472 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
219 |
123 |
$15K |
| D2160 |
|
135 |
91 |
$11K |
| D9610 |
|
119 |
118 |
$10K |
| D9222 |
|
80 |
80 |
$10K |
| D1510 |
|
57 |
40 |
$6K |
| D0601 |
|
295 |
294 |
$4K |
| D9248 |
|
88 |
86 |
$3K |
| D2140 |
|
34 |
26 |
$2K |
| D1110 |
Prophylaxis - adult |
15 |
15 |
$1K |
| D0602 |
|
90 |
90 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
13 |
$764.40 |
| D1999 |
|
187 |
187 |
$736.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
237 |
231 |
$294.00 |
| D8660 |
|
13 |
13 |
$0.00 |