| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,626 |
8,519 |
$491K |
| D1110 |
Prophylaxis - adult |
4,966 |
4,912 |
$410K |
| D0120 |
Periodic oral evaluation - established patient |
9,464 |
9,401 |
$255K |
| D1120 |
Prophylaxis - child |
13,250 |
13,100 |
$145K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
721 |
517 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,376 |
18,194 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,179 |
651 |
$37K |
| D8660 |
|
516 |
495 |
$34K |
| D1351 |
Sealant - per tooth |
12,757 |
3,282 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
645 |
500 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
649 |
623 |
$26K |
| D0330 |
Panoramic radiographic image |
940 |
907 |
$25K |
| D0272 |
Bitewings - two radiographic images |
9,661 |
9,559 |
$19K |
| D8670 |
Periodic orthodontic treatment visit |
239 |
237 |
$16K |
| D1330 |
|
18,487 |
18,250 |
$16K |
| D0274 |
Bitewings - four radiographic images |
4,750 |
4,702 |
$10K |
| D9920 |
|
320 |
234 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
8,894 |
8,737 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,911 |
7,516 |
$5K |
| D1206 |
Topical application of fluoride varnish |
323 |
321 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16 |
14 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
136 |
136 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
279 |
276 |
$3K |
| D1517 |
|
12 |
12 |
$1K |
| D1354 |
|
157 |
55 |
$292.31 |
| D0601 |
|
532 |
482 |
$251.00 |
| D3120 |
|
30 |
24 |
$240.42 |
| D0602 |
|
133 |
110 |
$95.00 |
| D0603 |
|
45 |
39 |
$25.00 |