| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
47,792 |
41,019 |
$668K |
| D7140 |
Extraction, erupted tooth or exposed root |
12,357 |
7,437 |
$521K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,118 |
5,325 |
$486K |
| D1120 |
Prophylaxis - child |
18,168 |
17,285 |
$437K |
| D1351 |
Sealant - per tooth |
15,703 |
4,455 |
$280K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,078 |
3,789 |
$277K |
| D0140 |
Limited oral evaluation - problem focused |
13,297 |
11,869 |
$267K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,403 |
9,955 |
$241K |
| D0120 |
Periodic oral evaluation - established patient |
13,819 |
13,146 |
$239K |
| D0274 |
Bitewings - four radiographic images |
10,703 |
10,233 |
$209K |
| D1354 |
|
24,428 |
6,230 |
$203K |
| D1110 |
Prophylaxis - adult |
5,928 |
5,621 |
$184K |
| D0330 |
Panoramic radiographic image |
4,466 |
4,251 |
$177K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,502 |
1,198 |
$135K |
| D0191 |
|
9,660 |
9,089 |
$112K |
| D0220 |
Intraoral - periapical first radiographic image |
13,888 |
12,440 |
$112K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,418 |
1,172 |
$100K |
| D0272 |
Bitewings - two radiographic images |
6,249 |
5,948 |
$92K |
| D0210 |
Intraoral - complete series of radiographic images |
846 |
812 |
$49K |
| D0270 |
|
4,521 |
4,215 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,228 |
3,592 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,027 |
999 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
85 |
71 |
$10K |
| D4346 |
|
39 |
39 |
$4K |
| D2940 |
|
137 |
103 |
$3K |
| D4355 |
|
50 |
44 |
$3K |
| D2330 |
|
56 |
37 |
$3K |
| D9110 |
|
105 |
98 |
$2K |
| D0350 |
|
126 |
109 |
$2K |
| D2394 |
|
30 |
27 |
$2K |
| D2335 |
|
15 |
12 |
$1K |
| D0460 |
|
570 |
552 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
580 |
472 |
$0.00 |
| D4921 |
|
123 |
109 |
$0.00 |
| D9215 |
|
19,707 |
16,789 |
$0.00 |
| D1310 |
|
134 |
131 |
$0.00 |
| D1330 |
|
24,867 |
23,593 |
$0.00 |
| D3120 |
|
1,415 |
1,131 |
$0.00 |
| D3110 |
|
45 |
40 |
$0.00 |