| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12,657 |
12,634 |
$695K |
| D1120 |
Prophylaxis - child |
12,830 |
12,787 |
$496K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,536 |
4,498 |
$480K |
| D0230 |
Intraoral - periapical each additional radiographic image |
68,290 |
13,741 |
$280K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,850 |
13,814 |
$183K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,464 |
2,463 |
$152K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,889 |
2,092 |
$147K |
| D1310 |
|
2,749 |
2,739 |
$125K |
| D0274 |
Bitewings - four radiographic images |
5,326 |
5,323 |
$109K |
| D0210 |
Intraoral - complete series of radiographic images |
2,331 |
2,323 |
$106K |
| D1351 |
Sealant - per tooth |
3,804 |
1,132 |
$104K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,234 |
974 |
$93K |
| D9993 |
|
1,183 |
1,183 |
$76K |
| D1110 |
Prophylaxis - adult |
870 |
870 |
$72K |
| D2330 |
|
683 |
431 |
$50K |
| D0350 |
|
4,955 |
3,407 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
832 |
552 |
$45K |
| D0272 |
Bitewings - two radiographic images |
3,693 |
3,683 |
$42K |
| D8670 |
Periodic orthodontic treatment visit |
127 |
127 |
$37K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
350 |
241 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,773 |
2,738 |
$31K |
| D0603 |
|
1,587 |
1,583 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
551 |
551 |
$19K |
| D9430 |
|
460 |
447 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
279 |
265 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
202 |
202 |
$10K |
| D9248 |
|
216 |
215 |
$7K |
| D4341 |
|
96 |
37 |
$7K |
| D2331 |
|
72 |
54 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
43 |
29 |
$5K |
| D0602 |
|
250 |
250 |
$4K |
| D4910 |
|
24 |
24 |
$2K |
| D1354 |
|
12 |
12 |
$385.00 |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$242.00 |
| D0270 |
|
13 |
13 |
$65.00 |