| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
30,584 |
30,484 |
$1.79M |
| D1120 |
Prophylaxis - child |
37,198 |
37,062 |
$1.51M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,337 |
6,687 |
$878K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,782 |
2,507 |
$794K |
| D1310 |
|
9,171 |
9,134 |
$410K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,108 |
4,345 |
$381K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,502 |
5,482 |
$360K |
| D1351 |
Sealant - per tooth |
11,613 |
3,774 |
$338K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,462 |
7,191 |
$294K |
| D1208 |
Topical application of fluoride, excluding varnish |
25,434 |
25,350 |
$281K |
| D0274 |
Bitewings - four radiographic images |
12,071 |
12,038 |
$256K |
| D9993 |
|
4,120 |
4,119 |
$252K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33,090 |
21,135 |
$249K |
| D1206 |
Topical application of fluoride varnish |
11,108 |
11,058 |
$246K |
| D0272 |
Bitewings - two radiographic images |
20,640 |
20,550 |
$244K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,430 |
1,232 |
$237K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,791 |
2,166 |
$214K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,916 |
2,909 |
$181K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
795 |
250 |
$163K |
| D0330 |
Panoramic radiographic image |
5,254 |
5,235 |
$154K |
| D0350 |
|
9,402 |
6,920 |
$118K |
| D0603 |
|
6,529 |
6,507 |
$94K |
| D0220 |
Intraoral - periapical first radiographic image |
6,995 |
6,885 |
$82K |
| D9248 |
|
2,285 |
2,176 |
$77K |
| D9430 |
|
1,900 |
1,863 |
$60K |
| D2330 |
|
688 |
444 |
$52K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
538 |
423 |
$42K |
| D9222 |
|
250 |
250 |
$31K |
| D0602 |
|
1,844 |
1,837 |
$27K |
| D9610 |
|
478 |
253 |
$21K |
| D1510 |
|
34 |
28 |
$4K |
| D2390 |
|
37 |
12 |
$4K |
| D0601 |
|
176 |
176 |
$3K |
| D1354 |
|
43 |
24 |
$840.00 |
| D7111 |
|
14 |
12 |
$803.60 |