| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,192 |
9,156 |
$570K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,577 |
1,499 |
$540K |
| D1120 |
Prophylaxis - child |
12,286 |
12,245 |
$496K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,458 |
2,061 |
$311K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,267 |
2,590 |
$282K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,271 |
4,263 |
$280K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,104 |
4,951 |
$197K |
| D1206 |
Topical application of fluoride varnish |
12,233 |
12,190 |
$164K |
| D1351 |
Sealant - per tooth |
4,449 |
1,599 |
$129K |
| D0274 |
Bitewings - four radiographic images |
5,515 |
5,495 |
$117K |
| D2140 |
|
1,944 |
1,401 |
$104K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,547 |
5,649 |
$88K |
| D0210 |
Intraoral - complete series of radiographic images |
1,601 |
1,596 |
$75K |
| D7240 |
Removal of impacted tooth - completely bony |
289 |
143 |
$67K |
| D9430 |
|
1,958 |
1,829 |
$63K |
| D1310 |
|
1,191 |
1,176 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
4,024 |
3,969 |
$48K |
| D0330 |
Panoramic radiographic image |
1,560 |
1,553 |
$44K |
| D0272 |
Bitewings - two radiographic images |
2,800 |
2,793 |
$33K |
| D2160 |
|
271 |
207 |
$22K |
| D0145 |
Oral evaluation for a patient under three years of age |
261 |
261 |
$17K |
| D0350 |
|
1,853 |
1,112 |
$16K |
| D0603 |
|
472 |
467 |
$7K |
| D0601 |
|
402 |
397 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
109 |
83 |
$6K |
| D2330 |
|
65 |
43 |
$5K |
| D7220 |
|
20 |
14 |
$3K |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$1K |
| D0270 |
|
188 |
158 |
$848.00 |
| D0602 |
|
42 |
42 |
$630.00 |
| D9610 |
|
54 |
54 |
$567.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
16 |
16 |
$138.00 |