| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
31,640 |
31,547 |
$1.74M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13,026 |
3,145 |
$1.53M |
| D1120 |
Prophylaxis - child |
33,601 |
33,465 |
$1.29M |
| D0230 |
Intraoral - periapical each additional radiographic image |
172,517 |
42,410 |
$706K |
| D2140 |
|
12,675 |
6,494 |
$680K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
3,134 |
1,297 |
$670K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,519 |
1,671 |
$643K |
| D1351 |
Sealant - per tooth |
15,569 |
5,630 |
$439K |
| D1208 |
Topical application of fluoride, excluding varnish |
34,847 |
34,700 |
$432K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,273 |
3,862 |
$418K |
| D0274 |
Bitewings - four radiographic images |
18,323 |
18,258 |
$385K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,555 |
3,395 |
$374K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,796 |
7,671 |
$305K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,134 |
4,126 |
$252K |
| D1310 |
|
6,095 |
6,074 |
$243K |
| D0350 |
|
19,491 |
9,588 |
$202K |
| D9222 |
|
1,270 |
1,264 |
$156K |
| D0220 |
Intraoral - periapical first radiographic image |
12,532 |
12,333 |
$147K |
| D0272 |
Bitewings - two radiographic images |
12,606 |
12,567 |
$146K |
| D9993 |
|
3,611 |
3,610 |
$97K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,106 |
1,106 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,150 |
685 |
$61K |
| D0601 |
|
3,860 |
3,851 |
$55K |
| D0330 |
Panoramic radiographic image |
1,168 |
1,158 |
$33K |
| D9430 |
|
809 |
792 |
$25K |
| D2330 |
|
332 |
208 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
324 |
209 |
$22K |
| D0603 |
|
1,388 |
1,387 |
$18K |
| D9610 |
|
541 |
158 |
$13K |
| D1510 |
|
96 |
66 |
$11K |
| D2160 |
|
100 |
69 |
$8K |
| D0602 |
|
373 |
373 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
13 |
$2K |