| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
19,631 |
19,507 |
$1.11M |
| D1120 |
Prophylaxis - child |
21,516 |
21,421 |
$855K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,198 |
4,322 |
$543K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,867 |
3,706 |
$315K |
| D1206 |
Topical application of fluoride varnish |
17,990 |
17,917 |
$244K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,465 |
3,452 |
$225K |
| D0230 |
Intraoral - periapical each additional radiographic image |
48,727 |
13,662 |
$191K |
| D1310 |
|
3,872 |
3,850 |
$177K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,288 |
1,698 |
$130K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,793 |
2,630 |
$110K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,594 |
1,593 |
$99K |
| D0350 |
|
8,590 |
4,966 |
$85K |
| D0272 |
Bitewings - two radiographic images |
6,852 |
6,829 |
$80K |
| D9993 |
|
1,196 |
1,196 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
6,237 |
6,199 |
$71K |
| D1110 |
Prophylaxis - adult |
790 |
783 |
$71K |
| D1351 |
Sealant - per tooth |
1,728 |
449 |
$61K |
| D2330 |
|
613 |
382 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
504 |
384 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
808 |
808 |
$38K |
| D0603 |
|
2,437 |
2,420 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,092 |
1,086 |
$22K |
| D0602 |
|
1,348 |
1,342 |
$20K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
180 |
130 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
116 |
89 |
$11K |
| D3240 |
|
70 |
53 |
$7K |
| D4910 |
|
69 |
69 |
$5K |
| D4341 |
|
38 |
12 |
$3K |
| D9430 |
|
12 |
12 |
$384.00 |
| D1999 |
|
71 |
70 |
$120.00 |
| D0270 |
|
13 |
13 |
$65.00 |