| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,581 |
2,571 |
$170K |
| D0120 |
Periodic oral evaluation - established patient |
2,080 |
2,068 |
$147K |
| D1120 |
Prophylaxis - child |
3,071 |
3,058 |
$134K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,849 |
746 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,377 |
731 |
$91K |
| D1110 |
Prophylaxis - adult |
997 |
990 |
$84K |
| D0210 |
Intraoral - complete series of radiographic images |
1,670 |
1,659 |
$78K |
| D2332 |
|
650 |
159 |
$59K |
| D1351 |
Sealant - per tooth |
1,628 |
466 |
$52K |
| D1310 |
|
1,040 |
1,039 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,092 |
3,126 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,221 |
2,215 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,742 |
1,731 |
$30K |
| D9430 |
|
810 |
745 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,099 |
2,063 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,207 |
1,197 |
$22K |
| D0350 |
|
2,153 |
856 |
$21K |
| D9993 |
|
372 |
372 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
430 |
381 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
205 |
113 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
55 |
55 |
$3K |
| D0602 |
|
216 |
216 |
$3K |
| D0603 |
|
211 |
211 |
$3K |
| D4910 |
|
43 |
43 |
$3K |
| D0272 |
Bitewings - two radiographic images |
45 |
45 |
$540.00 |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$420.00 |
| D0601 |
|
24 |
24 |
$360.00 |