| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
4,893 |
4,041 |
$266K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,569 |
4,392 |
$226K |
| D1110 |
Prophylaxis - adult |
5,085 |
4,035 |
$214K |
| D1120 |
Prophylaxis - child |
3,665 |
3,581 |
$138K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,406 |
751 |
$133K |
| D0120 |
Periodic oral evaluation - established patient |
5,042 |
4,382 |
$132K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
507 |
155 |
$101K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
724 |
444 |
$60K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,508 |
1,339 |
$59K |
| D1206 |
Topical application of fluoride varnish |
1,940 |
1,894 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,516 |
2,457 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
3,514 |
3,058 |
$49K |
| D1351 |
Sealant - per tooth |
1,452 |
575 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,069 |
2,548 |
$37K |
| D0274 |
Bitewings - four radiographic images |
862 |
606 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
155 |
100 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
321 |
307 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
111 |
59 |
$11K |
| D0272 |
Bitewings - two radiographic images |
249 |
240 |
$6K |
| D0240 |
|
53 |
40 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$2K |