| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,886 |
8,646 |
$210K |
| D1110 |
Prophylaxis - adult |
4,934 |
4,804 |
$206K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,876 |
9,592 |
$198K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,549 |
1,360 |
$182K |
| D1120 |
Prophylaxis - child |
5,233 |
5,121 |
$174K |
| D0210 |
Intraoral - complete series of radiographic images |
2,896 |
2,806 |
$161K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,094 |
1,117 |
$125K |
| D1351 |
Sealant - per tooth |
4,414 |
1,544 |
$123K |
| D0274 |
Bitewings - four radiographic images |
3,830 |
3,720 |
$100K |
| D1353 |
|
3,678 |
1,232 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,331 |
571 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,115 |
2,031 |
$57K |
| D4342 |
|
1,286 |
310 |
$42K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
221 |
127 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,152 |
1,139 |
$20K |
| D1206 |
Topical application of fluoride varnish |
967 |
956 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
682 |
664 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
605 |
576 |
$12K |
| D4355 |
|
153 |
143 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
863 |
740 |
$9K |
| D1354 |
|
1,289 |
239 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
24 |
14 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
60 |
45 |
$5K |
| D4910 |
|
81 |
68 |
$4K |
| D0330 |
Panoramic radiographic image |
15 |
13 |
$654.71 |
| D0230 |
Intraoral - periapical each additional radiographic image |
50 |
29 |
$90.69 |