| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,699 |
7,657 |
$340K |
| D1351 |
Sealant - per tooth |
8,340 |
2,723 |
$292K |
| D0120 |
Periodic oral evaluation - established patient |
10,264 |
10,200 |
$241K |
| D0350 |
|
4,335 |
3,529 |
$151K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,361 |
834 |
$143K |
| D1120 |
Prophylaxis - child |
4,237 |
4,200 |
$139K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,155 |
6,085 |
$132K |
| D0274 |
Bitewings - four radiographic images |
3,972 |
3,948 |
$118K |
| D8660 |
|
837 |
836 |
$116K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,063 |
533 |
$105K |
| D0220 |
Intraoral - periapical first radiographic image |
7,334 |
7,215 |
$93K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
538 |
338 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,132 |
5,083 |
$65K |
| D1206 |
Topical application of fluoride varnish |
3,161 |
3,131 |
$60K |
| D0330 |
Panoramic radiographic image |
912 |
900 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,117 |
1,102 |
$44K |
| D0272 |
Bitewings - two radiographic images |
1,018 |
1,013 |
$21K |
| D0340 |
|
299 |
298 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
402 |
398 |
$14K |
| D3120 |
|
274 |
138 |
$10K |
| D9219 |
|
195 |
194 |
$8K |
| D8670 |
Periodic orthodontic treatment visit |
60 |
60 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
193 |
187 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
162 |
157 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
21 |
12 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
27 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
39 |
39 |
$1K |