| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,123 |
6,500 |
$329K |
| D0120 |
Periodic oral evaluation - established patient |
11,242 |
10,199 |
$287K |
| D0272 |
Bitewings - two radiographic images |
10,010 |
9,149 |
$221K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,220 |
651 |
$212K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,139 |
8,787 |
$211K |
| D0220 |
Intraoral - periapical first radiographic image |
11,295 |
10,037 |
$190K |
| D1120 |
Prophylaxis - child |
4,690 |
4,287 |
$161K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,756 |
7,026 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,889 |
987 |
$126K |
| D0210 |
Intraoral - complete series of radiographic images |
1,452 |
1,408 |
$115K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,985 |
2,949 |
$99K |
| D0140 |
Limited oral evaluation - problem focused |
2,378 |
2,140 |
$74K |
| D1206 |
Topical application of fluoride varnish |
3,578 |
3,332 |
$70K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
892 |
490 |
$69K |
| D0330 |
Panoramic radiographic image |
1,389 |
1,243 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
499 |
265 |
$37K |
| D2140 |
|
592 |
351 |
$37K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
272 |
96 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
639 |
347 |
$35K |
| D1351 |
Sealant - per tooth |
925 |
254 |
$25K |
| D0603 |
|
3,188 |
2,707 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
439 |
427 |
$14K |
| D0602 |
|
2,866 |
2,636 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
76 |
55 |
$10K |
| D0601 |
|
2,023 |
1,976 |
$9K |
| D2332 |
|
81 |
54 |
$9K |
| D2160 |
|
91 |
68 |
$8K |
| D2931 |
|
41 |
28 |
$6K |
| D7111 |
|
96 |
54 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
22 |
12 |
$2K |
| D1320 |
|
15 |
14 |
$375.00 |