| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,001 |
11,000 |
$432K |
| D0120 |
Periodic oral evaluation - established patient |
16,936 |
16,898 |
$348K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,732 |
4,372 |
$335K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,574 |
1,960 |
$231K |
| D0330 |
Panoramic radiographic image |
7,356 |
7,353 |
$226K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
558 |
547 |
$218K |
| D1206 |
Topical application of fluoride varnish |
6,139 |
6,139 |
$183K |
| D0272 |
Bitewings - two radiographic images |
7,776 |
7,776 |
$103K |
| D3320 |
|
320 |
311 |
$94K |
| D1354 |
|
6,359 |
2,216 |
$92K |
| D9310 |
|
3,167 |
3,167 |
$91K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,645 |
5,644 |
$70K |
| D0274 |
Bitewings - four radiographic images |
3,296 |
3,296 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
7,603 |
7,580 |
$62K |
| D1351 |
Sealant - per tooth |
1,299 |
802 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
5,068 |
5,045 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,131 |
2,131 |
$60K |
| D1110 |
Prophylaxis - adult |
1,676 |
1,676 |
$60K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
591 |
591 |
$55K |
| D9222 |
|
854 |
854 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,174 |
1,083 |
$54K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
457 |
337 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
781 |
746 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,189 |
4,132 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,770 |
2,706 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
2,044 |
2,037 |
$18K |
| D3310 |
|
53 |
49 |
$13K |
| D0240 |
|
660 |
657 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
169 |
169 |
$5K |
| D9610 |
|
213 |
213 |
$849.30 |
| D0270 |
|
40 |
40 |
$269.93 |
| D9920 |
|
13 |
13 |
$220.86 |
| D9215 |
|
1,108 |
1,085 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
622 |
589 |
$0.00 |
| D1330 |
|
5,501 |
5,500 |
$0.00 |
| D9630 |
|
702 |
701 |
$0.00 |
| D5899 |
|
130 |
119 |
$0.00 |