| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
7,017 |
5,554 |
$2.15M |
| D0220 |
Intraoral - periapical first radiographic image |
6,418 |
4,990 |
$677K |
| D1206 |
Topical application of fluoride varnish |
6,967 |
5,406 |
$340K |
| D1120 |
Prophylaxis - child |
2,650 |
2,007 |
$314K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,300 |
1,009 |
$282K |
| D0120 |
Periodic oral evaluation - established patient |
1,710 |
1,259 |
$264K |
| D0330 |
Panoramic radiographic image |
1,783 |
1,478 |
$207K |
| D1110 |
Prophylaxis - adult |
1,162 |
847 |
$178K |
| D1351 |
Sealant - per tooth |
6,970 |
1,239 |
$141K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,877 |
1,596 |
$127K |
| D0272 |
Bitewings - two radiographic images |
993 |
716 |
$113K |
| D0274 |
Bitewings - four radiographic images |
899 |
661 |
$90K |
| D2940 |
|
3,145 |
1,364 |
$88K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
189 |
145 |
$25K |
| D1354 |
|
178 |
74 |
$18K |
| D1330 |
|
874 |
693 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
143 |
73 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
896 |
115 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
92 |
68 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,691 |
827 |
$8K |
| D0270 |
|
67 |
56 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
146 |
94 |
$4K |
| D1352 |
|
48 |
13 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
32 |
12 |
$3K |
| D2335 |
|
22 |
12 |
$2K |
| D2331 |
|
15 |
12 |
$640.00 |
| D1310 |
|
663 |
648 |
$0.00 |
| D9215 |
|
477 |
458 |
$0.00 |
| D0603 |
|
175 |
172 |
$0.00 |
| D1320 |
|
67 |
64 |
$0.00 |
| D0190 |
|
457 |
424 |
$0.00 |
| D0460 |
|
61 |
55 |
$0.00 |
| D0191 |
|
120 |
120 |
$0.00 |