| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
34,783 |
34,485 |
$831K |
| D1110 |
Prophylaxis - adult |
18,219 |
18,078 |
$831K |
| D1206 |
Topical application of fluoride varnish |
35,500 |
35,192 |
$680K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,774 |
1,533 |
$609K |
| D1120 |
Prophylaxis - child |
15,738 |
15,597 |
$531K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,822 |
2,190 |
$419K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,660 |
2,293 |
$375K |
| D0274 |
Bitewings - four radiographic images |
11,961 |
11,842 |
$365K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,528 |
1,519 |
$339K |
| D2140 |
|
3,281 |
2,081 |
$297K |
| D1351 |
Sealant - per tooth |
7,825 |
3,248 |
$274K |
| D7240 |
Removal of impacted tooth - completely bony |
991 |
306 |
$272K |
| D0272 |
Bitewings - two radiographic images |
9,956 |
9,804 |
$210K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,440 |
5,210 |
$170K |
| D0330 |
Panoramic radiographic image |
3,242 |
3,240 |
$165K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,247 |
6,242 |
$163K |
| D0220 |
Intraoral - periapical first radiographic image |
9,414 |
9,358 |
$121K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,529 |
1,518 |
$62K |
| D4346 |
|
1,185 |
1,183 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
1,213 |
1,201 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
1,478 |
1,464 |
$41K |
| D2934 |
|
240 |
71 |
$40K |
| D9243 |
|
143 |
143 |
$38K |
| D2160 |
|
275 |
182 |
$34K |
| D7111 |
|
304 |
212 |
$16K |
| D9310 |
|
387 |
386 |
$16K |
| D9239 |
|
144 |
144 |
$16K |
| D0240 |
|
449 |
443 |
$15K |
| D0350 |
|
397 |
338 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
423 |
418 |
$13K |
| D1353 |
|
345 |
252 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
98 |
69 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
108 |
39 |
$9K |
| D4342 |
|
97 |
42 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
28 |
$6K |
| D9944 |
|
14 |
14 |
$4K |
| D1352 |
|
91 |
62 |
$3K |
| D2331 |
|
20 |
14 |
$2K |
| D1354 |
|
166 |
75 |
$1K |
| D0460 |
|
12 |
12 |
$322.08 |