| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,835 |
12,172 |
$518K |
| D1351 |
Sealant - per tooth |
6,389 |
3,398 |
$452K |
| D0120 |
Periodic oral evaluation - established patient |
14,474 |
13,726 |
$397K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,522 |
4,027 |
$354K |
| D4341 |
|
1,793 |
1,068 |
$325K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,370 |
11,746 |
$315K |
| D9110 |
|
5,223 |
4,646 |
$279K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,496 |
1,825 |
$235K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,521 |
1,924 |
$186K |
| D0274 |
Bitewings - four radiographic images |
8,643 |
8,192 |
$148K |
| D1110 |
Prophylaxis - adult |
3,330 |
3,149 |
$136K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,682 |
2,121 |
$125K |
| D0220 |
Intraoral - periapical first radiographic image |
20,394 |
18,884 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,044 |
4,808 |
$113K |
| D0140 |
Limited oral evaluation - problem focused |
5,954 |
5,499 |
$99K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,300 |
14,955 |
$91K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,353 |
1,058 |
$68K |
| D0210 |
Intraoral - complete series of radiographic images |
1,988 |
1,827 |
$34K |
| D0272 |
Bitewings - two radiographic images |
3,100 |
2,944 |
$30K |
| D2740 |
Crown - porcelain/ceramic |
111 |
95 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
654 |
577 |
$27K |
| D2332 |
|
269 |
191 |
$26K |
| D2335 |
|
109 |
90 |
$10K |
| D8670 |
Periodic orthodontic treatment visit |
39 |
36 |
$9K |
| D0330 |
Panoramic radiographic image |
328 |
320 |
$6K |
| D2330 |
|
84 |
76 |
$6K |
| D0270 |
|
814 |
798 |
$4K |
| D2331 |
|
59 |
44 |
$4K |
| D4910 |
|
51 |
51 |
$3K |
| D8999 |
|
67 |
65 |
$3K |
| D2950 |
|
38 |
38 |
$2K |
| D1206 |
Topical application of fluoride varnish |
73 |
73 |
$2K |
| D4342 |
|
18 |
12 |
$1K |
| D2394 |
|
13 |
12 |
$1K |
| D9310 |
|
70 |
69 |
$837.90 |
| D0603 |
|
14 |
14 |
$270.00 |
| D0340 |
|
27 |
26 |
$0.00 |