| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
15,444 |
15,348 |
$1.06M |
| D1120 |
Prophylaxis - child |
19,574 |
19,459 |
$933K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,543 |
2,934 |
$508K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,346 |
2,565 |
$417K |
| D0230 |
Intraoral - periapical each additional radiographic image |
89,170 |
17,294 |
$372K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,317 |
19,206 |
$333K |
| D1310 |
|
6,209 |
6,163 |
$283K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,379 |
903 |
$281K |
| D2330 |
|
3,065 |
964 |
$233K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,182 |
800 |
$213K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,078 |
4,879 |
$203K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,479 |
2,471 |
$171K |
| D1351 |
Sealant - per tooth |
4,574 |
1,436 |
$142K |
| D8670 |
Periodic orthodontic treatment visit |
389 |
389 |
$114K |
| D0272 |
Bitewings - two radiographic images |
8,862 |
8,818 |
$104K |
| D0274 |
Bitewings - four radiographic images |
4,636 |
4,608 |
$99K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,669 |
897 |
$94K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,221 |
1,212 |
$87K |
| D9430 |
|
1,848 |
1,812 |
$59K |
| D0603 |
|
3,916 |
3,882 |
$58K |
| D7111 |
|
819 |
485 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
3,649 |
3,611 |
$43K |
| D0350 |
|
3,599 |
1,580 |
$40K |
| D9993 |
|
585 |
585 |
$38K |
| D9920 |
|
292 |
283 |
$35K |
| D0601 |
|
1,769 |
1,761 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
545 |
545 |
$19K |
| D0330 |
Panoramic radiographic image |
577 |
577 |
$17K |
| D1510 |
|
78 |
60 |
$12K |
| D2331 |
|
68 |
39 |
$5K |
| D0602 |
|
115 |
115 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
22 |
22 |
$1K |
| D1354 |
|
43 |
13 |
$516.00 |