| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
24,470 |
24,399 |
$1.36M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,952 |
4,226 |
$1.29M |
| D1120 |
Prophylaxis - child |
28,919 |
28,838 |
$1.13M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
10,851 |
4,131 |
$1.07M |
| D0230 |
Intraoral - periapical each additional radiographic image |
148,560 |
28,773 |
$602K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,170 |
4,739 |
$543K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,300 |
10,896 |
$443K |
| D1208 |
Topical application of fluoride, excluding varnish |
28,822 |
28,741 |
$412K |
| D1310 |
|
7,878 |
7,847 |
$356K |
| D1351 |
Sealant - per tooth |
11,971 |
3,804 |
$351K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,800 |
3,331 |
$330K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,631 |
3,478 |
$304K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,940 |
3,938 |
$258K |
| D9993 |
|
3,481 |
3,479 |
$210K |
| D0350 |
|
15,539 |
8,858 |
$201K |
| D0272 |
Bitewings - two radiographic images |
13,766 |
13,730 |
$161K |
| D0220 |
Intraoral - periapical first radiographic image |
12,527 |
12,186 |
$147K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,397 |
2,389 |
$147K |
| D0274 |
Bitewings - four radiographic images |
6,387 |
6,367 |
$136K |
| D2330 |
|
1,328 |
907 |
$101K |
| D1510 |
|
691 |
592 |
$91K |
| D0603 |
|
5,175 |
5,154 |
$76K |
| D9430 |
|
1,424 |
1,397 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
498 |
434 |
$39K |
| D0602 |
|
2,150 |
2,141 |
$32K |
| D9420 |
|
389 |
221 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
225 |
225 |
$10K |
| D0601 |
|
176 |
176 |
$3K |