| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12,081 |
12,031 |
$658K |
| D1120 |
Prophylaxis - child |
13,383 |
13,315 |
$493K |
| D0230 |
Intraoral - periapical each additional radiographic image |
74,147 |
13,087 |
$300K |
| D1351 |
Sealant - per tooth |
8,630 |
3,027 |
$232K |
| D2140 |
|
4,201 |
2,365 |
$224K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,934 |
1,668 |
$193K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,527 |
2,525 |
$157K |
| D7240 |
Removal of impacted tooth - completely bony |
614 |
251 |
$142K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,481 |
11,426 |
$117K |
| D0210 |
Intraoral - complete series of radiographic images |
2,402 |
2,394 |
$112K |
| D0274 |
Bitewings - four radiographic images |
5,207 |
5,180 |
$110K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,723 |
2,608 |
$106K |
| D0350 |
|
8,262 |
4,408 |
$88K |
| D1310 |
|
1,514 |
1,507 |
$68K |
| D1110 |
Prophylaxis - adult |
744 |
744 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,060 |
601 |
$60K |
| D9993 |
|
914 |
912 |
$58K |
| D1206 |
Topical application of fluoride varnish |
2,317 |
2,308 |
$45K |
| D0330 |
Panoramic radiographic image |
1,328 |
1,328 |
$39K |
| D0272 |
Bitewings - two radiographic images |
2,383 |
2,370 |
$28K |
| D0340 |
|
432 |
431 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
484 |
484 |
$17K |
| D7230 |
|
87 |
48 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,206 |
1,202 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
100 |
63 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
96 |
60 |
$9K |
| D8670 |
Periodic orthodontic treatment visit |
24 |
24 |
$7K |
| D0603 |
|
435 |
432 |
$6K |
| D4910 |
|
55 |
55 |
$4K |
| D9430 |
|
113 |
106 |
$4K |
| D0602 |
|
127 |
124 |
$2K |
| D0601 |
|
66 |
66 |
$930.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$708.00 |