| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
16,715 |
16,554 |
$4.72M |
| D0140 |
Limited oral evaluation - problem focused |
17,013 |
15,491 |
$4.38M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,593 |
9,494 |
$2.59M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,899 |
5,286 |
$1.29M |
| D7140 |
Extraction, erupted tooth or exposed root |
8,245 |
5,117 |
$1.09M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,041 |
4,566 |
$1.04M |
| D5899 |
|
3,250 |
2,188 |
$915K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,850 |
1,573 |
$308K |
| D2330 |
|
888 |
600 |
$110K |
| D2331 |
|
855 |
643 |
$109K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
735 |
554 |
$92K |
| D2335 |
|
298 |
245 |
$50K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
178 |
166 |
$31K |
| D2332 |
|
115 |
89 |
$16K |
| D2394 |
|
59 |
51 |
$13K |
| D2140 |
|
36 |
30 |
$4K |
| D1354 |
|
30 |
12 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
18 |
13 |
$3K |
| D2940 |
|
55 |
49 |
$2K |
| D0330 |
Panoramic radiographic image |
8,314 |
8,228 |
$2K |
| D1110 |
Prophylaxis - adult |
13,194 |
13,058 |
$2K |
| D4355 |
|
1,617 |
1,593 |
$1K |
| D0274 |
Bitewings - four radiographic images |
12,818 |
12,676 |
$1K |
| D1206 |
Topical application of fluoride varnish |
16,995 |
16,791 |
$771.18 |
| D0220 |
Intraoral - periapical first radiographic image |
13,653 |
13,077 |
$499.09 |
| D1120 |
Prophylaxis - child |
8,505 |
8,420 |
$154.64 |
| D0272 |
Bitewings - two radiographic images |
4,503 |
4,464 |
$143.30 |
| D1330 |
|
2,082 |
2,050 |
$128.65 |
| D0270 |
|
3,087 |
3,028 |
$69.19 |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,419 |
2,078 |
$47.09 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
497 |
441 |
$0.00 |
| D9996 |
|
756 |
744 |
$0.00 |
| D0350 |
|
770 |
756 |
$0.00 |
| D9910 |
|
298 |
246 |
$0.00 |
| D0191 |
|
55 |
55 |
$0.00 |
| D1351 |
Sealant - per tooth |
7,275 |
2,086 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
333 |
330 |
$0.00 |
| D0240 |
|
1,119 |
645 |
$0.00 |
| D0602 |
|
39 |
39 |
$0.00 |
| D3120 |
|
55 |
48 |
$0.00 |
| D9920 |
|
28 |
27 |
$0.00 |
| D0603 |
|
194 |
194 |
$0.00 |
| D0601 |
|
50 |
50 |
$0.00 |