| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,298 |
4,055 |
$166K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,829 |
935 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
3,922 |
3,678 |
$101K |
| D1206 |
Topical application of fluoride varnish |
4,044 |
3,811 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,268 |
887 |
$82K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
640 |
462 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,892 |
1,881 |
$46K |
| D4341 |
|
285 |
130 |
$45K |
| D1351 |
Sealant - per tooth |
663 |
322 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
502 |
426 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
660 |
499 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,533 |
1,482 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
4,226 |
4,028 |
$25K |
| D1110 |
Prophylaxis - adult |
575 |
571 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
693 |
688 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,619 |
3,441 |
$20K |
| D8670 |
Periodic orthodontic treatment visit |
99 |
98 |
$19K |
| D2740 |
Crown - porcelain/ceramic |
56 |
45 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
871 |
845 |
$15K |
| D0272 |
Bitewings - two radiographic images |
969 |
930 |
$9K |
| D2331 |
|
54 |
41 |
$5K |
| D2330 |
|
58 |
41 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
33 |
$3K |
| D2950 |
|
41 |
38 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
90 |
90 |
$2K |
| D0270 |
|
313 |
303 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
15 |
$2K |
| D2332 |
|
17 |
14 |
$2K |
| D0601 |
|
1,151 |
1,036 |
$1.01 |
| D1999 |
|
31 |
24 |
$0.00 |