| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
28,615 |
27,990 |
$730K |
| D1110 |
Prophylaxis - adult |
15,707 |
15,411 |
$721K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
8,358 |
4,747 |
$635K |
| D0272 |
Bitewings - two radiographic images |
25,051 |
24,602 |
$557K |
| D1120 |
Prophylaxis - child |
14,211 |
13,891 |
$492K |
| D0240 |
|
20,917 |
19,967 |
$488K |
| D0220 |
Intraoral - periapical first radiographic image |
24,607 |
24,035 |
$411K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,556 |
3,112 |
$387K |
| D1206 |
Topical application of fluoride varnish |
17,567 |
17,131 |
$337K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,064 |
10,797 |
$296K |
| D0210 |
Intraoral - complete series of radiographic images |
3,923 |
3,800 |
$293K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,959 |
1,817 |
$267K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,798 |
9,818 |
$223K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,604 |
11,421 |
$223K |
| D2160 |
|
1,927 |
1,308 |
$165K |
| D2140 |
|
2,133 |
1,474 |
$130K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,273 |
791 |
$104K |
| D1351 |
Sealant - per tooth |
3,263 |
1,220 |
$89K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,450 |
945 |
$81K |
| D0603 |
|
15,620 |
15,277 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,052 |
2,043 |
$66K |
| D0330 |
Panoramic radiographic image |
1,954 |
1,913 |
$49K |
| D0602 |
|
7,997 |
7,880 |
$38K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
282 |
125 |
$35K |
| D7111 |
|
718 |
505 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
1,046 |
983 |
$32K |
| D2331 |
|
52 |
26 |
$4K |
| D2330 |
|
36 |
25 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13 |
12 |
$2K |
| D0601 |
|
87 |
74 |
$315.00 |