| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,825 |
4,463 |
$214K |
| D0120 |
Periodic oral evaluation - established patient |
6,933 |
6,677 |
$176K |
| D1110 |
Prophylaxis - adult |
2,562 |
2,407 |
$175K |
| D1120 |
Prophylaxis - child |
9,515 |
9,024 |
$122K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,095 |
698 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,858 |
12,201 |
$31K |
| D8660 |
|
319 |
309 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
885 |
800 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
628 |
433 |
$17K |
| D1351 |
Sealant - per tooth |
6,850 |
1,649 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
381 |
271 |
$14K |
| D0330 |
Panoramic radiographic image |
562 |
539 |
$13K |
| D0272 |
Bitewings - two radiographic images |
6,470 |
6,207 |
$12K |
| D1330 |
|
12,585 |
11,940 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
318 |
193 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
5,167 |
4,907 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,730 |
4,124 |
$4K |
| D0274 |
Bitewings - four radiographic images |
2,111 |
2,079 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
22 |
13 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
112 |
97 |
$2K |
| D1517 |
|
26 |
14 |
$2K |
| D9310 |
|
59 |
53 |
$2K |
| D9920 |
|
53 |
48 |
$823.63 |
| D8670 |
Periodic orthodontic treatment visit |
14 |
14 |
$746.42 |
| D0140 |
Limited oral evaluation - problem focused |
52 |
51 |
$527.90 |
| D1206 |
Topical application of fluoride varnish |
25 |
25 |
$327.52 |
| D3120 |
|
52 |
37 |
$80.42 |
| D0603 |
|
146 |
114 |
$66.00 |
| D0601 |
|
99 |
85 |
$38.00 |
| D0602 |
|
12 |
12 |
$2.00 |