| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
5,364 |
4,371 |
$2.25M |
| D1206 |
Topical application of fluoride varnish |
6,813 |
5,810 |
$1.69M |
| D1208 |
Topical application of fluoride, excluding varnish |
6,894 |
3,166 |
$979K |
| D0120 |
Periodic oral evaluation - established patient |
2,715 |
2,281 |
$699K |
| D0220 |
Intraoral - periapical first radiographic image |
3,993 |
3,324 |
$516K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,198 |
1,144 |
$135K |
| D1351 |
Sealant - per tooth |
2,778 |
644 |
$113K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
512 |
277 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
468 |
295 |
$79K |
| D0274 |
Bitewings - four radiographic images |
1,219 |
1,026 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
142 |
127 |
$37K |
| D1120 |
Prophylaxis - child |
984 |
842 |
$34K |
| D0272 |
Bitewings - two radiographic images |
776 |
685 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
286 |
187 |
$21K |
| D1110 |
Prophylaxis - adult |
583 |
467 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
182 |
124 |
$13K |
| D2140 |
|
110 |
59 |
$12K |
| D9310 |
|
2,370 |
1,660 |
$8K |
| D0330 |
Panoramic radiographic image |
276 |
231 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
55 |
27 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
150 |
109 |
$4K |
| D2330 |
|
37 |
13 |
$3K |
| D2331 |
|
21 |
12 |
$2K |
| D0270 |
|
71 |
67 |
$2K |
| D2940 |
|
38 |
25 |
$1K |
| D1310 |
|
280 |
202 |
$0.00 |
| D3120 |
|
35 |
29 |
$0.00 |
| D0170 |
|
171 |
125 |
$0.00 |
| D1330 |
|
314 |
227 |
$0.00 |
| D5899 |
|
98 |
43 |
$0.00 |
| D1354 |
|
1,537 |
230 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$0.00 |
| D0350 |
|
919 |
714 |
$0.00 |
| D0190 |
|
49 |
42 |
$0.00 |