| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,990 |
11,931 |
$670K |
| D1120 |
Prophylaxis - child |
12,844 |
12,773 |
$493K |
| D0230 |
Intraoral - periapical each additional radiographic image |
69,506 |
12,797 |
$286K |
| D1351 |
Sealant - per tooth |
9,586 |
3,114 |
$254K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,815 |
1,839 |
$247K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,517 |
1,908 |
$233K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,427 |
2,412 |
$153K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,248 |
13,176 |
$143K |
| D2160 |
|
1,724 |
1,140 |
$135K |
| D1110 |
Prophylaxis - adult |
1,200 |
1,196 |
$102K |
| D0272 |
Bitewings - two radiographic images |
8,404 |
8,372 |
$98K |
| D1310 |
|
2,025 |
2,015 |
$89K |
| D0210 |
Intraoral - complete series of radiographic images |
1,639 |
1,628 |
$74K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
930 |
604 |
$71K |
| D9993 |
|
1,090 |
1,090 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,213 |
665 |
$61K |
| D0274 |
Bitewings - four radiographic images |
2,535 |
2,517 |
$54K |
| D4910 |
|
695 |
691 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,085 |
950 |
$42K |
| D0350 |
|
4,575 |
2,304 |
$40K |
| D4341 |
|
466 |
124 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,637 |
2,613 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
499 |
346 |
$28K |
| D2140 |
|
401 |
247 |
$22K |
| D1320 |
|
899 |
896 |
$15K |
| D0603 |
|
892 |
888 |
$13K |
| D0601 |
|
809 |
805 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
119 |
93 |
$12K |
| D7240 |
Removal of impacted tooth - completely bony |
26 |
12 |
$6K |
| D9430 |
|
176 |
172 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
124 |
123 |
$5K |
| D2330 |
|
19 |
12 |
$1K |
| D2161 |
|
16 |
13 |
$1K |
| D0602 |
|
22 |
22 |
$30.00 |