| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
95,033 |
94,713 |
$5.08M |
| D1120 |
Prophylaxis - child |
113,937 |
113,510 |
$4.57M |
| D1351 |
Sealant - per tooth |
69,754 |
18,209 |
$2.18M |
| D0350 |
|
218,467 |
65,801 |
$1.88M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
15,873 |
7,517 |
$1.86M |
| D1208 |
Topical application of fluoride, excluding varnish |
113,887 |
113,471 |
$1.65M |
| D0230 |
Intraoral - periapical each additional radiographic image |
340,601 |
97,102 |
$1.36M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18,835 |
15,672 |
$1.24M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
28,816 |
27,986 |
$1.11M |
| D0274 |
Bitewings - four radiographic images |
46,544 |
46,387 |
$993K |
| D7140 |
Extraction, erupted tooth or exposed root |
16,275 |
10,492 |
$924K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,100 |
12,046 |
$764K |
| D1310 |
|
14,811 |
14,671 |
$690K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,835 |
4,134 |
$675K |
| D0145 |
Oral evaluation for a patient under three years of age |
9,312 |
9,269 |
$566K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,341 |
6,995 |
$444K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,632 |
902 |
$367K |
| D0272 |
Bitewings - two radiographic images |
29,136 |
29,042 |
$344K |
| D0220 |
Intraoral - periapical first radiographic image |
25,522 |
25,289 |
$305K |
| D0330 |
Panoramic radiographic image |
9,475 |
9,449 |
$276K |
| D9430 |
|
5,846 |
5,770 |
$184K |
| D9222 |
|
907 |
900 |
$104K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,321 |
1,276 |
$103K |
| D0603 |
|
6,021 |
5,951 |
$91K |
| D0601 |
|
4,408 |
4,370 |
$67K |
| D0602 |
|
3,609 |
3,574 |
$55K |
| D1510 |
|
147 |
130 |
$21K |
| D0270 |
|
1,806 |
1,788 |
$9K |
| D2330 |
|
56 |
39 |
$5K |
| D3230 |
|
37 |
13 |
$4K |
| D2940 |
|
19 |
13 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
1,269 |
1,264 |
$0.00 |