| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,290 |
4,259 |
$259K |
| D1120 |
Prophylaxis - child |
5,139 |
5,109 |
$195K |
| D0230 |
Intraoral - periapical each additional radiographic image |
42,010 |
7,372 |
$170K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,240 |
2,226 |
$135K |
| D1110 |
Prophylaxis - adult |
900 |
899 |
$77K |
| D0274 |
Bitewings - four radiographic images |
2,724 |
2,712 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,912 |
3,891 |
$43K |
| D1351 |
Sealant - per tooth |
1,686 |
511 |
$41K |
| D1206 |
Topical application of fluoride varnish |
2,106 |
2,091 |
$35K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
520 |
280 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
718 |
716 |
$33K |
| D0350 |
|
3,070 |
1,451 |
$32K |
| D2140 |
|
431 |
233 |
$22K |
| D9993 |
|
281 |
281 |
$18K |
| D0330 |
Panoramic radiographic image |
536 |
533 |
$15K |
| D1310 |
|
322 |
322 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
362 |
335 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
81 |
44 |
$10K |
| D7240 |
Removal of impacted tooth - completely bony |
35 |
15 |
$8K |
| D4341 |
|
100 |
26 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
87 |
40 |
$5K |
| D0272 |
Bitewings - two radiographic images |
386 |
385 |
$5K |
| D9430 |
|
138 |
137 |
$4K |
| D0340 |
|
64 |
64 |
$3K |
| D4910 |
|
42 |
42 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
27 |
12 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
75 |
75 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
194 |
194 |
$2K |
| D0603 |
|
42 |
42 |
$615.00 |
| D1320 |
|
14 |
14 |
$237.50 |