| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,279 |
5,250 |
$369K |
| D1120 |
Prophylaxis - child |
7,932 |
7,886 |
$365K |
| D8670 |
Periodic orthodontic treatment visit |
1,103 |
1,094 |
$322K |
| D1351 |
Sealant - per tooth |
6,957 |
1,775 |
$217K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,491 |
1,237 |
$164K |
| D0340 |
|
3,050 |
3,041 |
$152K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,180 |
2,168 |
$144K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32,898 |
6,420 |
$137K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,000 |
7,954 |
$128K |
| D1310 |
|
2,137 |
2,119 |
$96K |
| D0330 |
Panoramic radiographic image |
3,058 |
3,050 |
$90K |
| D0140 |
Limited oral evaluation - problem focused |
3,067 |
3,059 |
$81K |
| D0274 |
Bitewings - four radiographic images |
3,687 |
3,667 |
$76K |
| D0350 |
|
5,827 |
2,297 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
990 |
575 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,327 |
1,203 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
795 |
794 |
$37K |
| D0603 |
|
2,086 |
2,068 |
$31K |
| D0145 |
Oral evaluation for a patient under three years of age |
394 |
391 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
413 |
205 |
$23K |
| D9430 |
|
632 |
620 |
$20K |
| D9993 |
|
385 |
384 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,562 |
1,553 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,058 |
1,053 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
37 |
15 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
36 |
14 |
$4K |
| D2330 |
|
25 |
17 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
14 |
$1K |
| D1320 |
|
550 |
548 |
$258.50 |
| D1354 |
|
42 |
13 |
$228.00 |