| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
10,426 |
9,545 |
$5.31M |
| D0220 |
Intraoral - periapical first radiographic image |
18,437 |
17,034 |
$4.61M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,259 |
6,754 |
$2.00M |
| D1206 |
Topical application of fluoride varnish |
18,786 |
15,140 |
$1.50M |
| D1120 |
Prophylaxis - child |
3,275 |
3,097 |
$1.22M |
| D1351 |
Sealant - per tooth |
13,442 |
2,250 |
$687K |
| D1110 |
Prophylaxis - adult |
3,945 |
2,855 |
$617K |
| D0274 |
Bitewings - four radiographic images |
3,228 |
3,023 |
$110K |
| D9310 |
|
680 |
369 |
$100K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
372 |
131 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
226 |
133 |
$30K |
| D4910 |
|
422 |
347 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
218 |
179 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
145 |
74 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,138 |
6,796 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
43 |
37 |
$8K |
| D4342 |
|
126 |
36 |
$8K |
| D0330 |
Panoramic radiographic image |
221 |
215 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
354 |
263 |
$6K |
| D0460 |
|
1,579 |
1,373 |
$5K |
| D0272 |
Bitewings - two radiographic images |
187 |
184 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
45 |
25 |
$514.48 |
| D0270 |
|
13 |
13 |
$24.43 |
| D1999 |
|
1,950 |
1,874 |
$0.00 |
| D1354 |
|
472 |
84 |
$0.00 |
| D0180 |
|
163 |
92 |
$0.00 |
| D3120 |
|
39 |
14 |
$0.00 |
| D1330 |
|
4,624 |
3,500 |
$0.00 |
| D1310 |
|
16 |
15 |
$0.00 |