| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
14,437 |
14,214 |
$675K |
| D0120 |
Periodic oral evaluation - established patient |
23,384 |
22,988 |
$607K |
| D0272 |
Bitewings - two radiographic images |
21,366 |
21,044 |
$480K |
| D0240 |
|
17,671 |
16,405 |
$424K |
| D1120 |
Prophylaxis - child |
11,637 |
11,462 |
$409K |
| D0220 |
Intraoral - periapical first radiographic image |
21,401 |
20,965 |
$362K |
| D1206 |
Topical application of fluoride varnish |
15,844 |
15,618 |
$310K |
| D2140 |
|
4,562 |
2,409 |
$289K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,566 |
2,171 |
$278K |
| D0210 |
Intraoral - complete series of radiographic images |
3,295 |
3,213 |
$262K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,416 |
9,775 |
$260K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,307 |
2,418 |
$246K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,536 |
2,190 |
$241K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,934 |
9,793 |
$193K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,287 |
715 |
$174K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,554 |
6,316 |
$143K |
| D1351 |
Sealant - per tooth |
4,670 |
1,719 |
$128K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,210 |
2,205 |
$74K |
| D0603 |
|
14,589 |
14,357 |
$71K |
| D7111 |
|
1,377 |
849 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
1,594 |
1,537 |
$51K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
328 |
123 |
$43K |
| D0602 |
|
4,907 |
4,868 |
$23K |
| D2160 |
|
250 |
181 |
$23K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
273 |
189 |
$23K |
| D0330 |
Panoramic radiographic image |
1,310 |
1,293 |
$21K |
| D2330 |
|
254 |
166 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
194 |
74 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
45 |
39 |
$4K |
| D0601 |
|
63 |
61 |
$295.00 |