| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,113 |
9,112 |
$230K |
| D1120 |
Prophylaxis - child |
5,968 |
5,967 |
$224K |
| D8670 |
Periodic orthodontic treatment visit |
589 |
589 |
$165K |
| D1110 |
Prophylaxis - adult |
3,278 |
3,278 |
$157K |
| D0274 |
Bitewings - four radiographic images |
5,156 |
5,156 |
$131K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,972 |
1,167 |
$130K |
| D1351 |
Sealant - per tooth |
2,506 |
896 |
$109K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,955 |
7,935 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,913 |
5,913 |
$76K |
| D1206 |
Topical application of fluoride varnish |
2,434 |
2,434 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,286 |
832 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
524 |
382 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,462 |
1,462 |
$22K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
196 |
119 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,397 |
1,397 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
343 |
343 |
$13K |
| D0340 |
|
209 |
209 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
285 |
285 |
$8K |
| D1354 |
|
220 |
74 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
83 |
69 |
$7K |
| D0330 |
Panoramic radiographic image |
225 |
225 |
$7K |
| D8660 |
|
248 |
248 |
$7K |
| D0350 |
|
200 |
200 |
$2K |
| D0470 |
|
62 |
62 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
26 |
25 |
$780.00 |
| D0140 |
Limited oral evaluation - problem focused |
47 |
47 |
$606.82 |