| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
10,490 |
10,354 |
$490K |
| D0120 |
Periodic oral evaluation - established patient |
17,138 |
16,900 |
$445K |
| D0272 |
Bitewings - two radiographic images |
14,406 |
14,227 |
$319K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,638 |
14,442 |
$286K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,059 |
1,608 |
$240K |
| D1120 |
Prophylaxis - child |
6,742 |
6,643 |
$234K |
| D0210 |
Intraoral - complete series of radiographic images |
2,448 |
2,424 |
$202K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,620 |
1,348 |
$200K |
| D2140 |
|
2,533 |
1,493 |
$162K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,447 |
4,890 |
$139K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,920 |
1,065 |
$119K |
| D0603 |
|
12,546 |
12,402 |
$60K |
| D1351 |
Sealant - per tooth |
1,991 |
650 |
$54K |
| D1206 |
Topical application of fluoride varnish |
2,276 |
2,249 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
1,688 |
1,634 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
567 |
559 |
$19K |
| D0330 |
Panoramic radiographic image |
1,348 |
1,333 |
$17K |
| D2160 |
|
139 |
100 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
123 |
80 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
57 |
36 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
72 |
50 |
$7K |
| D0274 |
Bitewings - four radiographic images |
290 |
286 |
$5K |
| D0602 |
|
962 |
946 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
116 |
112 |
$4K |
| D0240 |
|
60 |
37 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
27 |
27 |
$691.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
51 |
36 |
$498.75 |
| D9986 |
|
307 |
286 |
$0.00 |
| D1999 |
|
574 |
527 |
$0.00 |