| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
67,454 |
67,212 |
$2.73M |
| D0120 |
Periodic oral evaluation - established patient |
40,672 |
40,536 |
$2.54M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16,755 |
7,647 |
$1.95M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24,533 |
13,342 |
$1.59M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
19,371 |
19,296 |
$1.23M |
| D1310 |
|
27,192 |
27,117 |
$1.22M |
| D1351 |
Sealant - per tooth |
40,910 |
12,497 |
$1.18M |
| D1208 |
Topical application of fluoride, excluding varnish |
61,871 |
61,658 |
$978K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
23,330 |
22,312 |
$915K |
| D0230 |
Intraoral - periapical each additional radiographic image |
212,035 |
60,722 |
$874K |
| D7140 |
Extraction, erupted tooth or exposed root |
14,011 |
7,181 |
$775K |
| D9993 |
|
11,197 |
11,196 |
$720K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,773 |
7,448 |
$619K |
| D0145 |
Oral evaluation for a patient under three years of age |
6,248 |
6,236 |
$393K |
| D3240 |
|
3,400 |
2,264 |
$330K |
| D0220 |
Intraoral - periapical first radiographic image |
28,194 |
27,766 |
$326K |
| D0272 |
Bitewings - two radiographic images |
24,430 |
24,322 |
$270K |
| D0274 |
Bitewings - four radiographic images |
13,574 |
13,523 |
$269K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
466 |
435 |
$264K |
| D0603 |
|
17,120 |
17,067 |
$251K |
| D0350 |
|
21,083 |
12,796 |
$208K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,510 |
1,882 |
$194K |
| D2330 |
|
1,939 |
1,206 |
$145K |
| D9430 |
|
3,541 |
3,475 |
$110K |
| D0601 |
|
7,566 |
7,554 |
$109K |
| D1510 |
|
714 |
676 |
$105K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
859 |
474 |
$84K |
| D2932 |
|
697 |
324 |
$72K |
| D0330 |
Panoramic radiographic image |
1,997 |
1,997 |
$55K |
| D9222 |
|
435 |
435 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
946 |
945 |
$43K |
| D9610 |
|
444 |
435 |
$36K |
| D9920 |
|
226 |
217 |
$15K |
| D2331 |
|
83 |
68 |
$6K |
| D1206 |
Topical application of fluoride varnish |
986 |
981 |
$5K |
| D0602 |
|
226 |
226 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
25 |
15 |
$3K |
| D2954 |
|
16 |
12 |
$2K |
| D0270 |
|
133 |
133 |
$650.00 |
| D1999 |
|
281 |
278 |
$506.00 |
| D1330 |
|
15 |
14 |
$0.00 |
| D9215 |
|
45 |
44 |
$0.00 |