| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,874 |
5,871 |
$180K |
| D0120 |
Periodic oral evaluation - established patient |
7,695 |
7,694 |
$152K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,394 |
1,697 |
$98K |
| D1206 |
Topical application of fluoride varnish |
3,323 |
3,319 |
$79K |
| D1110 |
Prophylaxis - adult |
2,443 |
2,442 |
$78K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,389 |
9,459 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,671 |
2,670 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
5,199 |
5,179 |
$47K |
| D1351 |
Sealant - per tooth |
1,503 |
503 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,182 |
4,179 |
$44K |
| D0274 |
Bitewings - four radiographic images |
2,260 |
2,260 |
$43K |
| D0272 |
Bitewings - two radiographic images |
3,196 |
3,196 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
3,966 |
3,916 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
1,495 |
1,494 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
581 |
433 |
$32K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
183 |
87 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
423 |
325 |
$16K |
| D9310 |
|
261 |
261 |
$12K |
| D0270 |
|
1,344 |
1,340 |
$11K |
| D1354 |
|
655 |
207 |
$10K |
| D0330 |
Panoramic radiographic image |
325 |
324 |
$9K |
| D9995 |
|
503 |
482 |
$2K |
| D0160 |
|
62 |
62 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
139 |
135 |
$1K |
| D4341 |
|
21 |
13 |
$992.27 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
12 |
$870.32 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
147 |
144 |
$450.67 |
| D9110 |
|
26 |
25 |
$391.72 |
| D0190 |
|
641 |
637 |
$0.00 |
| D0601 |
|
818 |
818 |
$0.00 |
| D1330 |
|
5,807 |
5,805 |
$0.00 |
| D0603 |
|
2,575 |
2,574 |
$0.00 |
| D1310 |
|
5,559 |
5,558 |
$0.00 |
| D0170 |
|
1,083 |
1,033 |
$0.00 |
| D0602 |
|
310 |
310 |
$0.00 |
| D3999 |
|
96 |
83 |
$0.00 |
| D6999 |
|
15 |
14 |
$0.00 |
| D5899 |
|
80 |
64 |
$0.00 |