| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
16,287 |
16,165 |
$860K |
| D1120 |
Prophylaxis - child |
16,820 |
16,706 |
$639K |
| D0230 |
Intraoral - periapical each additional radiographic image |
122,594 |
19,553 |
$493K |
| D1351 |
Sealant - per tooth |
9,267 |
2,747 |
$251K |
| D8670 |
Periodic orthodontic treatment visit |
862 |
862 |
$239K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,532 |
16,428 |
$212K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,740 |
2,726 |
$167K |
| D1310 |
|
3,188 |
3,176 |
$144K |
| D1110 |
Prophylaxis - adult |
1,719 |
1,707 |
$139K |
| D0272 |
Bitewings - two radiographic images |
11,761 |
11,692 |
$137K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
877 |
513 |
$104K |
| D9993 |
|
1,466 |
1,465 |
$93K |
| D0210 |
Intraoral - complete series of radiographic images |
1,818 |
1,809 |
$84K |
| D0274 |
Bitewings - four radiographic images |
3,690 |
3,664 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,005 |
660 |
$67K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
978 |
579 |
$65K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
125 |
94 |
$60K |
| D7240 |
Removal of impacted tooth - completely bony |
211 |
89 |
$49K |
| D4341 |
|
660 |
179 |
$46K |
| D9430 |
|
1,390 |
1,378 |
$43K |
| D0603 |
|
2,569 |
2,557 |
$38K |
| D0330 |
Panoramic radiographic image |
1,243 |
1,239 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
900 |
870 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
382 |
268 |
$21K |
| D2140 |
|
356 |
239 |
$19K |
| D7111 |
|
287 |
235 |
$16K |
| D4910 |
|
120 |
120 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
261 |
261 |
$9K |
| D0350 |
|
882 |
577 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
151 |
150 |
$8K |
| D2740 |
Crown - porcelain/ceramic |
14 |
13 |
$7K |
| D0602 |
|
304 |
304 |
$4K |
| D2952 |
|
33 |
26 |
$3K |
| D4342 |
|
40 |
16 |
$2K |
| D0270 |
|
12 |
12 |
$60.00 |